A Supportive Beliefs Intervention To Facilitate The .
School Mental Health (2015) 7:49–60DOI 10.1007/s12310-014-9139-3ORIGINAL PAPERA Supportive Beliefs Intervention to Facilitate the Implementationof Evidence-Based Practices Within a Multi-Tiered Systemof SupportsClayton R. Cook Aaron R. Lyon Dajana Kubergovic Diana Browning WrightYanchen Zhang Published online: 21 January 2015 Springer Science Business Media New York 2015Abstract The current study represents a preliminaryexamination of school-level beliefs and attitudes as theyrelate to the implementation of universal evidence-basedpractices (EBPs) within a multi-tiered system of support(MTSS) targeting student’s social, emotional, and behavioral problems. This study was organized around threeprimary objectives: (a) assess coaches’ perceptions of theutility and importance of targeting educator beliefs toimprove adoption and use of EBPs, (b) demonstrate theassociation between educator beliefs and degree of MTSSimplementation, and (c) conduct a preliminary pre–posttestof a supportive belief intervention (SBI) to enhance educators’ beliefs and examine whether changes in beliefswere associated with improved implementation. Toaccomplish these objectives, data were collected from 62elementary schools across five school districts involved ina collaborative consultative partnership to design andimplement a school-wide MTSS framework. Collectively,the results provided preliminary support for the importanceof beliefs: (a) coaches reported beliefs were critical toimplementation and facilitative of their roles working withteachers, (b) educator beliefs predicted initial implementation fidelity on a global measure of MTSS practices andspecific measure of school-wide positive behavior interventions and supports, and (c) the SBI was associated withsignificant changes in educator beliefs and these changeswere associated with improved implementation. TheC. R. Cook (&) A. R. Lyon D. Kubergovic Y. ZhangUniversity of Washington, Seattle, WA, USAe-mail: cook2142@yahoo.comD. Browning WrightDiana Browning Wright Consulting, Inc., Sierra Madre, CA,USAimplications, limitations, and future directions of thisresearch are discussed.Keywords Implementation Social, emotional, andbehavioral (SEB) Evidence-based practices (EBPs) Multi-tiered systems of support (MTSS)IntroductionStudies indicate that approximately one out of every fivestudents has a diagnosable mental health disorder (Costello, Mustillo, Erkanli, Keler, & Angold, 2003). Manymore exhibit milder forms of social, emotional, andbehavioral (SEB) problems that do not reach clinical levels, but nevertheless negatively impact academic achievement (Goodman, Joyce, & Smith, 2011), are associatedwith an increased likelihood of short- and long-term negative outcomes (Beesdo & Knappe, 2012), and, in somecircumstances, may also impede their classmates’ learning(Trout, Nordness, Pierce, & Epstein, 2003). As a result,there is burgeoning interest in school mental health toprevent social, emotional, and educational problems(Durlak, Weissberg, Dymnicki, Taylor & Schellinger,2011).Multi-Tiered Systems of Support (MTSS)A multi-tiered system of support (MTSS) has been advocated as a way to organize and deliver a continuum ofevidence-based practices (EBPs) to address students’ SEBneeds (EBPs; Cook, Burns, Browning-Wright, & Gresham,2010). MTSS is a proactive, prevention-oriented servicedelivery framework that aims to meet all students’ needsthrough the implementation of a continuum of EBPs via123
50data-driven decision making (Strein, Hoagwood, & Cohn,2003). The continuum of EBPs consists of delivering universal (i.e., Tier 1) supports for all students, selected (i.e.,Tier 2) interventions for some students, and indicated (i.e.,Tier 3) treatments for a few students. Although researchhas demonstrated that numerous EBPs can be implementedwithin a MTSS framework, multiple barriers interfere withtheir uptake and sustained use under natural educationalconditions (Forman et al., 2012). Barriers include insufficient post-training consultation (i.e., ‘‘train and hope’’)(Joyce & Showers, 2002), unsupportive leadership (Aarons, 2006), and policies that are counterproductive to theimplementation of new innovations (Slavin, 2002).Bridging the Implementation GapIncreasingly, research is focusing on understandingimplementation processes and identifying strategies thathelp transfer research findings into community-based socialservice settings (Powell et al., 2012). Given the limited useof EBPs in schools, researchers and educational leadershave also called for the identification of multi-level strategies that facilitate the use of effective practices in theeducation sector (Forman et al., 2013; Owens et al., 2014).In particular, multiple components of the inner organizational context (i.e., the settings and individuals involved inimplementation efforts) have been identified that influenceimplementation success and represent specific pinpoints forimplementation enhancement interventions. These includeorganizational climate—defined as personnel’s perceptionsof, and emotional reactions to, the characteristics of theirwork setting (Aarons & Sawitzky, 2006), principal leadership (Elias et al., 1997), and organizational citizenship—defined as behaviors that go beyond the standard ‘‘call ofduty’’ or core job aspects (Organ et al., 2006).The characteristics of the school organizational contextdescribed above can be distinguished from the steps orapproaches needed to actually install an EBP. For instance,effective professional development has been shown to be akey ingredient for quality installation of innovativeeducational programs (Penuel, Fishman, Yamaguchi, &Gallagher, 2007). Studies have demonstrated that, to besuccessful, professional development should also incorporate coaching to facilitate EBP implementation in schools(Joyce & Showers, 2002). Coaching represents a form offacilitative process that helps implementers comprehendthe purpose of the intervention, internalize interventiondelivery, and adapt the intervention to the context (Dusenbury et al., 2005). Coaching has emerged as a promisingstrategy that enhances relevant implementation (i.e.,appropriateness and fidelity) and student (e.g., behavioraland academic) outcomes in the context of EBP implementation over and above those observed via standard123School Mental Health (2015) 7:49–60professional development activities (Bradshaw et al., 2012;Haskins & Loeb, 2007). Unfortunately, findings demonstrate that many implementers are ambivalent or resistantto coaching interactions and that implementation maysuffer as a result (Dart, Cook, Gresham, Collins, & Chenier, 2012). For these reasons, coaching alone may beinsufficient to produce high levels of implementation(Fixsen, Blase, Naoom, & Wallace, 2009).Educator Beliefs and AttitudesResearch supports the view that the beliefs and attitudes ofpurveyors or implementers are likely to influence theuptake and use of EBPs (Nelson & Steele, 2007).Researchers in numerous fields, including education, havealso narrowed in on the importance of implementer beliefsand attitudes to the utilization of EBPs (Aarons & Palinkas,2007; Haney, Czerniak, & Lumpe, 1996). In recognition ofthe role of beliefs and attitudes, Lyon, Stirman, Kerns, andBruns (2011) advocated for the development of effectivemethods of increasing professionals’ motivation to implement new innovations in their practice. Specifically, theyidentified existing motivational enhancement strategies thattake direction from contemporary theories of motivation(e.g., Fishbein et al., 2001) to identify specific areas forimprovement in order to build provider commitment (e.g.,Feifer et al., 2006). However, limited to no attention hasfocused on intervening with educators on their beliefs priorto and throughout implementation.Beliefs and attitudes among educators have been arguedto be a prerequisite to significant change in practices andimprovement in outcomes within schools (Guskey, 1986).Both qualitative and quantitative researches support theview that educators’ beliefs toward certain practices andtheir own professional roles are likely to influence theuptake and use of EBPs (Bowden, Lanning, Pippin, &Tanner, 2003; Parcel, O’Hara-Tompkins, Harrist, & BasenEngquist, 1995). For example, teacher beliefs have beenshown to correlate with SWPBIS implementation fidelity(Kincaid et al., 2007) and their willingness to adopt andimplement social–emotional learning curricula (Brackett,Reyes, Rivers, Elbertson, & Salovey, 2012). Moreover,educators who possess a belief that components of someEBPs are detrimental to students (e.g., that extrinsic reinforcement—a key component of SWPBIS and some SELprograms—harms intrinsic motivation) may have limitedintentions to implement those EBP (Maag, 2001). Unfortunately, the extant literature is correlational in nature, withfew studies explicitly focusing on ways to promote supportive beliefs and attitudes as an implementationenhancement strategy. Pre-implementation interventionsthat focus on altering beliefs and attitudes prior to actualimplementation are likely to pay significant dividends
School Mental Health (2015) 7:49–60during the subsequent phases of the implementation process (e.g., implementation and sustainment) when professionals’ attitudes about EBP become particularly salient(Aarons et al., 2011).Researchers have advocated for the use of theory indesigning interventions to improve implementation, astheoretically informed interventions are likely to be moreeffective if they focus on causal determinants of humanbehavior. Social-cognitive theories, in particular the theoryof planned behavior (TPB), have been argued to be usefulin the formation of implementation enhancement interventions (Eccles et al., 2005). The TPB was developed topredict and explain human behavior in specific contexts(Ajzen & Manstead, 2007). The TPB states that an individual’s intention to carry out a given behavior is the mostpotent predictor of behavior (Fishbein & Ajzen, 1975).According to the TPB, the recipe for successful adoptionand implementation of EBP is an implementer who hassupportive beliefs about the intervention, perceives there tobe social expectations/pressure to implement the practices,and believes in one’s capability to implement the practiceand that doing so will make a relevant difference (Eccleset al., 2007). However, to date, limited to no research hasexamined the potential impact of integrating this theoryinto an intervention to promote better implementation.Purpose of the Present StudyConsidering the role of implementer beliefs and theimportance of developing theoretically informed interventions, the purpose of this study was to examine theimportance of educator beliefs and attitudes as they relateto the adoption and use of EBPs targeting students’ SEBfunctioning. This study was conducted in the context of acollaborative partnership with several school districts todevelop and implement a behavioral multi-tiered system ofsupport (B-MTSS) framework in an effort to promotebetter social, emotional, and academic outcomes. Weorganized this research according to three specific objectives. The first objective was to examine coaches’ perceptions of the importance (i.e., represents an importantaspect of the implementation process) and utility (i.e.,makes coaching easier and more effective) of addressingeducator beliefs and attitudes to facilitate implementationof practices associated with a B-MTSS framework. Thesecond objective was to examine whether educators’beliefs collected pre- and post-PD and coaching wereassociated with the degree to which elements of theB-MTSS framework were being implemented with fidelity.The last objective was to conduct a pre–posttest to examinewhether a supportive belief intervention (SBI) was able toproduce significant, positive changes in educators’ beliefsand attitudes over time, and whether changes in beliefs51were correlated with global and specific measures assessingfidelity of implementation. It is important to note that thisrepresents a preliminary study examining the role of educator beliefs as they relate to implementation of MTSSpractices.Based on the research objectives outlined above, we hadseveral hypotheses. First, we postulated that coaches wouldreport that beliefs are critical to implementation success.Second, we hypothesized that educator beliefs and attitudeswould be predictive of school-level MTSS implementationfidelity broadly and of SW-PBIS fidelity specifically.Third, we predicted that we would observe a significantchange in educators’ beliefs across schools following theSBI and this change would be associated with improvedimplementation outcomes.MethodsParticipating SchoolsA total of 62 elementary schools across five school districtswere included in this study. These schools were drawnfrom districts that were participating in system-widereform efforts to implement a B-MTSS. Districts werelocated in different geographic regions of the USA: Midwest, Southern California, and Northern California. Intotal, there were a total of 24,118 students enrolled in theseschools. The demographic data on the students in theparticipating elementary schools were as follows: gender(51 % male and 49 % female), ethnicity (48 % White,19 % Hispanic/Latino, 18 % Asian/Pacific Islander, 13 %African American, and 2 % Other), and socioeconomicstatus (38 % free and reduced lunch). Moreover, 13.7 % ofthe students in the schools were receiving special educationservices.There were a total of 1,181 educators (94 administrators,1,071 teachers, and 16 coaches) who participated in thestudy. As for educator demographics, the average years inthe profession were 7.6 (SD 4.1) for teachers, 8.3(SD 5.2) for administrators, and 9.8 (SD 3.5) forcoaches. The ethnic breakdown of educators was 78 %Caucasian, 8 % Asian/Pacific Islander, 6 % AfricanAmerican, 3 % Hispanic/Latino, and 6 % other. The schooldistricts experienced an average staff attrition rate of 24 %per year (range 14–35 %). At the outset of the study, noschool districts were implementing a system-wideapproach to addressing student SEB needs.Coaches were existing employees within the schooldistrict whose positions were repurposed to providecoaching supports to individual schools on the implementation of the B-MTSS, including providing performancebased feedback on the implementation of practices,123
52modeling certain practices when needed, and engaging in aproblem-solving process with school teams to overcomebarriers to implementation. These coaches were selectedgiven their prior experience and training in consultationand coaching methods and received specialized trainingand support (e.g., two additional days of professionaldevelopment, attendance at coaching conferences/workshops, and maintained ongoing communication with theoutside consultants) to facilitate the development of theircontent expertise. The two days of coaching professionaldevelopment consisted training them in data-based decision making (e.g., fidelity rubrics to track implementationpractices and inform performance-based feedback), theproblem-solving method (problem identification, problemanalysis, generate plan, plan implementation, and planevaluation), and effective coaching techniques (e.g.,motivational interviewing techniques, rapport building,group facilitation). Coaches were primarily school psychologists (n 10), but also included former site administrators (n 3) and school social workers (n 3).ProceduresThe school districts contacted the first and last authors toengage in a multi-year, district-wide initiative to implement a B-MTSS targeting students’ SEB needs. All thedata were collected as part of the B-MTSS initiative tofacilitate program evaluation and create a feedback systemto improve future implementation. IRB approval wasobtained and no identifying student information wasgathered as part of the data collection process. TheB-MTSS initiative was designed based on a horizontal(within tiers of support) and vertical (across tiers of support) integration of EBPs framework (Domitrovich et al.,2010) to facilitate implementing a continuum of supportsand making ongoing decisions about students and practicesbased on data. This model is discussed in greater detail inother sources (Sprague, Cook, Browning Wright, & Sadler,2008; Cook, Browning Wright, Gresham, & Burns, 2010).Consistent with system change literature, this initiativewas designed as a three-year project in which participatingschools build capacity over time to ultimately build themodel to scale (Aarons, Hurlburt, & Horwitz, 2011). Therewere a total of four PD sessions during the first year. EachPD session entailed 2 days, each lasting 6 h (total of 8 sixhour days). The number of PD days was systematicallydecreased to 6 days during the second year and 4 daysduring the third year. The initiative was grounded in atrain-the-trainer model of implementation with embeddedcoaching provided to each of the participating schoolsbetween each of the professional development sessions.External consultants (a researcher first author and professional educational consultant last author) trained each of123School Mental Health (2015) 7:49–60the site-based teams to be indigenous trainers and disseminators back at their site in order to build internalexpertise within each school. Coaches attended all PDsessions and supported teams’ efforts to disseminateinformation and implement practices back at their schoolsite.The teams included site administrators, professionalsupport staff (school psychologist, counselor, and/orbehavior specialist), two general education teachers, andtwo special education teachers. School administrators wereinstructed to select influential members of their buildingwho were open and willing to support implementationefforts back at the school site (Atkins et al., 2008). Timewas reserved at the end of each professional developmentsession to create an action plan (what will be done, whowill do it, what resources are needed to do it, and by whenwill it be done) based on each school’s identified prioritiesto incrementally implement the content and practicesassociated with the B-MTSS. The main content for the firstPD session were modeled activities to promote educatorbeliefs with regard to supporting student SEB functioning(see below description of SBI), while only a little time wasdevoted to new SBI activities during the remaining PDsessions. However, for all PD sessions, teams wereinstructed to review their school-level beliefs and developaction items to deliver aspects of the SBI.The initiative emphasized a sequential yet recursiveprocess of establishing readiness and scaling up implementation of key practices of the B-MTSS framework. Thefirst step in this process was to establish beliefs and attitudes that are supportive of the adoption and use ofeffective practices. Knowledge and skills represented thenext component of the system change process. Theknowledge component of the system change process was todeliver specific content that focused on developing theconceptual and practical understanding of the practices thatpopulate the B-MTSS framework. The skills component ofthe system change approach consisted of breaking downeach of the practices into its constituent practices (e.g.,progressive system of responding to problem behavior—proximity, redirection tactics, ongoing monitoring to reinforce desirable behavior, effective command, and teachinginteraction with the student) and teaching educators how toimplement practices with fidelity using a tell-show-doapproach. The last component of the system change process was to develop specific procedures that would facilitate the sustainment of implementation. These proceduresincluded periodic administrative walk-through observations to monitor implementation, structured professionallearning community meetings about specific practicesincluded within the B-MTSS framework, and de
A Supportive Beliefs Intervention to Facilitate the Implementation . in the formation of implementation enhancement inter-ventions (Eccles et al., 2005). The TPB was developed to predict and explain human behavior in specific contexts (Ajzen & Manstead, 2007). The TPB states that an indi-
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