School-wide systems of positive behavior support: A framework for reducing school crime and violence
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Permanent Link: http://ufdc.ufl.edu/IR00000475/00001
 Material Information
Title: School-wide systems of positive behavior support: A framework for reducing school crime and violence
Series Title: Scott, T., Gagnon, J. C., & Nelson, C. M. (2008). School-wide systems of positive behavior support: A framework for reducing school crime and violence. Journal of Behavior Analysis of Offender and Victim - Treatment and Prevention, 1, 259-272.
Physical Description: Journal Article
Creator: Gagnon, Joseph
 Notes
Abstract: School-wide positive behavior support (SWPBS) currently is implemented in over 7,000 elementary, middle, and high schools throughout the United States. Among the beneficial outcomes reported by these schools are dramatic reductions in office discipline referral rates, increased instructional time for students formerly removed for disciplinary reasons, and improved academic performance (including gains in academic year achievement test scores). While additional research concerning the effects of specific SWPBS components (especially outcomes of secondary and tertiary prevention efforts) and mediating factors is needed, there is a great deal of evidence that SWPBS is a significant part of a comprehensive and effective approach to school safety (Sugai & Horner, 2005). In this article, we review conceptual and empirical foundations for the distinguishing characteristics of PBS and discuss the application of each of these characteristics as a means to enhance school safety.
Acquisition: Collected for University of Florida's Institutional Repository by the UFIR Self-Submittal tool. Submitted by Joseph Gagnon.
Publication Status: Published
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Source Institution: University of Florida Institutional Repository
Holding Location: University of Florida
Rights Management: All rights reserved by the submitter.
System ID: IR00000475:00001

Full Text


















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Oftfilder and Victim Treatmn


TABLE OF CONTENTS
Brief Report: Theoretical Interpretation of Deception: Application to malingering, Halina Dziewolska St. Joseph's University & Donald Hantula Temple University
........................................2 37..........................................................................................................................................................723 7
Can Preschoolers Resist the Lures of Known and Unknown Perpetrators?: A Preliminary Examination of the Efficacy of a Behavioral Abduction Prevention
Program, Laurie Goldfarb and Richard O'Brien, Hofstra University, Elisa Krackow, Binghamton University, State University of New York...240
Beyond Crime and Punishment: Reconceptualizing the school disciplinary ladder through a PBS model, R. Anthony Doggett, Mississippi State University, J. Dale
Bailey, Fluency Plus, Inc., Kristin N. Johnson-Gros, M ississippi State University......................................... ....... .....................................247
School-Wide Systems of Positive Behavior Support: A Framework for Reducing School Crime and Violence, Terrance M. Scott, University of Louisville, Joseph
Calvin Gagnon, Ph.D., University of Florida, & C. M ichael Nelson, University of Louisville .................................................. ..........................259
Promising Directions for the Treatment of Complex Childhood Trauma: The Intergenerational Trauma Treatment Model, Katreena L. Scott and Valerie E. Copping
..........................................................................................................................................................................................................
Case Formulation with Sex Offenders: An Illustration of Individualized Risk Assessment, James Vess, Tony Ward, and Rachael Collie, Victoria University of
W ellin gton ..................................................................................................................................................................
Behavior Analysis and Childhood Conduct Problems Back to the Future: A Review of Dermot O'Reilly's Conduct Disorders and Behavioral Parent Training,
Arlene Wallace, Ph.D., Ellwyn & Joseph Cautilli, Ph.D., St. Joseph's University, Department of Criminal Justice..............................................296








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Lead Editor:
Joseph Cautilli, Ph.D., BCBA - Children's Crisis Treatment Center, Philadelphia, PA

Senior Associate Editors:
Jack Apsche, Ph.D., ABPP - The Apsche Center for Evidence Based Psychology, Yardley, PA
Dave Kingsley, Ph.D.
Kirk A. B. Newing, Ph.D. - Nebraska Department of Correctional Services

Associate Editors
Matt Tincani, Ph.D. - University of Nevada, Las Vegas
John Glass, Ph.D. - Colin County Community College
Paul Malanga - State of Tennessee
Kathy L. Hurley, Ph.d., BCBA, LMHC, DABS, CFAE - Private Practice


EDITORIAL REVIEW BOARD MEMBERS
Marvin H. Berman, Ph.D.
Arthur W. Blume, Ph.D. - University of North Carolina, Charlotte,
NC
Alexander L. Chapman, Ph.D. - Simon Fraser University,
Vancouver, Canada
R. Trent Codd, III, Ed.S., LPC - Cognitive -Behavioral Therapy
Center of WNC, Asheville, NC
Deborah Haas MSEd. - Temple University Episcopal Campus,
Philadelphia, PA
Jeffrey S. Danforth, Ph.D. - Eastern Connecticut State University
Deborah Davis, Ph.D. - University of Reno, NV
Karola Dillenburger, Ph.D. - Queen's University of Belfast,
Northern Ireland
Mark R. Dixon, Ph.D. - Southern Illinois University, IL
Bradley Donohue, Ph.D. - University of Nevada, Las Vegas, NV
Glen Dunlap, Ph.D. - University of South Florida
Halina Dziewolska, MS.Ed., BCBA - St. Joseph's University
Department of Criminal Justice
Dennis Embry, Ph.D. - Paxis Institute, Tuscon, AZ
Sheila Anne French
Frank Gardner, Ph.D., ABPP - La Salle University, Philadelphia,
PA
Jeannie Golden
D. Corydon Hammond, Ph.D. - University Of Utah School of
Medicine, Salt Lake City, Utah
Dana Lewis Haraway, Ph.D. - University of West Florida
Kathleen Hine, Ph.D. - University of Kansas
Tana Hope, Ph.D. - The Kennedy Krieger Institute and Johns
Hopkins School of Medicine
Aaron "Dusty" Jones, BCABA - behaviorMachine.com, Denton,
TX
Lee Ker, Ph.D. - Lehigh University, Bethlehem, PA
Kim Killu, Ph.D., BCBA - University of Michigan-Dearborn
Charlotte M. Kimmel, Ph.D. - Mexia State School, Limestone
County, TX
Kimberly C. Kirby, Ph.D. - Treatment Research Institute,
Philadelphia, PA
Alan Leschied, Ph.D. - University of Western Ontario, Canada



Layout and Final Editor:
C.A. Thomas, Ph.D., BCBA, NBTS, LLC. Mississippi Behavior Clinic


James Luiselli, Ph.D., ABPP, BCBA - The May Institute,
Randolph, MA
Douglas B. Marlowe, J.D., Ph.D. - Treatment Research Institute,
Philadelphia, PA
Cheryl B. McNeil, Ph.D. - West Virginia University
Robert W. Montgomery, Ph.D., BCBA - Reinforcement Unlimited,
Woodstock, GA
Todd Moore, Ph.D. - University of Tennessee
Alina Morawska, Ph.D. - University of Queensland
Nancy M Petry, Ph.D. - University of Connecticut Health Center
Robert F. Putnam, Ph.D., BCBA - The May Institute
Jerry Rea, Ph.D - State of Kansas
George F Ronan, Ph.D. - Central Michigan University
Ralph Serin, Ph.D. - Carleton University, Ottawa, Canada
Paul Strand, Ph.D. - Washington State University
Peter Sturmey, Ph.D. - Queens College and The Graduate Center,
City University of New York
William M. Tyson, Ph.D. - Blue Ridge Behavior Systems, Inc.
Tary J. Tobin, Ph.D. - University of Oregon
Vincent Van Hasselt, Ph.D. - Nova Southeastern University, Ft.
Lauderdale, FL
Michael Voltaire, Ph.D., BCBA - Nova Southeastern University,
Ft. Lauderdale, FL
George von Hilsheimer, Ph.D., F.R.S.H. - American Society of
Humanistic Education
Robert L Trestman Ph.D. M.D. - University of Connecticut Health
Center
Timothy Raymond Vollmer, Ph.D. - University of Florida
Gina Richman, Ph.D. - Assistant Professor Johns Hopkins School
of Medicine and Kennedy Krieger Institute
Robyn D. Walser, Ph.D. - National Center for PTSD & MIRECC,
VA Palo Alto Health Care System
Tony Ward, Ph.D. - Victoria University of Wellington
Lonny R Webb - Manager of Behavior and Risk Services for
Oregon Department of Corrections
Michael Weinberg, Ph.D.
Joseph W Wyatt, Ph.D. - Marshall University, Huntington, WV


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Dziewolska & Hantula JOBA OVTP


BRIEF REPORT: THEORETICAL INTERPRETATION OF DECEPTION: APPLICATION TO
MALINGERING
Halina Dziewolska St. Joseph's University & Donald Hantula Temple University

In this study, we treated a nine-year-old male with a history of malingering behavior. We judged the effect of treatment using a
multiple baseline design across home and school settings. After we collected baseline rates of illness statements, an intervention
consisting of instruction and partial removal of the task took place. During the intervention phase, the malingering statements no
longer led to task escape and illness statements decreased to near zero. Malingering is sensitive to environmental consequences
and a behavioral approach can successfully treat malingering behavior.


Cautilli & Hantula, (2001) hold that
deception functions as evolved operant behavior,
which can provide advantages to the organism. One
subclass of deceptive behavior, which has great
social implications, is malingering. Malingering is
defined as an intentional behavior patterns which are
either false or exaggerated illness with the goal of
obtaining compensation (positive reinforcement),
avoiding work (negative reinforcement), or escape
from criminal prosecution (negative reinforcement)
(APA, 2001). In the behavior analytic sense, all
people would be susceptible to some level of
malingering, depending on the environmental level of
payoff (Cautilli & Hantula, 2001). A person can
directly engage in malingering behavior (i.e., a
person who fakes illness to receive social security
benefits or worker's compensation) or by proxy (i.e.,
a parent fakes that his or her child has illness to
collect social security disability). This study attempts
to apply this case conceptualization to the treatment
of a nine-year-old boy with a growing problem with
stating that he was sick to avoid tasks.
Method
Participant
Participant was a nine-year-old boy in a
learning support classroom in a large urban public
elementary school. Both a psychiatrist and a
neurologist evaluated the child's complains of
illnesses and stated they were not from the
medication and that the child was in good physical
health. He has been taking 5 mg of Concerta Ix/day
for 2 years. The psychiatrist diagnosed the participant
with Attention Deficit Hyperactivity Disorder
Combined Type, Mixed Expressive-Receptive
Language Disorder, Learning Disorder and an Axis II
diagnosis of Developmental Delay.
Setting
The intervention took place in the child's
home and in the learning support classroom. The
school setting was a typical learning support
classroom with teacher, teacher aide, and one


bachelor level assistant (B.A.). The B.A's sole
function was to work with the participant. Eleven
other children were in this class.
Assessment of Behavior/ Function
The participant stated that he had illness
from 2-3x/week at home and 3-4x/week at school.
The team observed the topography of the
participant's behavior as putting his head down on
the desk and saying "I'm sick", or "I have a
headache," or "I don't feel good," or "I have chicken
pox."
The author assessed the function of the
malingering through functional assessment, which
involved the following steps (1) interview of the
teacher and parent and (2) direct observation in both
the home and the school using an ABC-event
recording procedure. Interviews suggested that the
function was either escape or attention based. Timing
of the complaints were not at regular points during
the day and complaints of headaches were forgotten
by the participant once work assignments were
removed. The observations revealed, the participant
had a high probability of stating he was ill just after
receiving a command (100%) of the time although
not after every command, as opposed to low
probability (0%) when no task given. During the
course of the school day, the participant usually
received about 8-12 tasks. In addition, participant
displayed the behavior about one out of every 20
tasks given (5% of the time). More specifically,
when the teacher assigned a writing task at school or
parent assigned a cleaning task at home, the
probability of saying he was sick would increase to
approximately to one out of three times.
Procedure
During the intervention, the team allowed
the participant to escape half of his task for stating
that he does not want to do the work. By making this
competing behavior more efficient and not allowing
the participant to escape work when he complains of
pain problems, frequency and duration of


237


Dziewolska & Hantula


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Dziewolska & Hantula


complaining behavior w
prior to the intervention
received an instruction
intervention consisted o
team stating to the part
pain just not to do his w
not believe him if he wi
may not receive
help appropriate for
being in pain or
sick.
Inter-observer
Agreement
We looked
at incidents where
the child made the
statements of
illness (IOA during
antecedent
condition only).
The teacher
(school), parent
(home), orB.A.
(school) would
write if she
believed it was
malingering on an
index card. The
first author
compared their
observation with
her own, and
percentage of
agreement was
calculated. Of the
ten statements
compared all team
members agreed on
all statements. Thus, 1(
between author with on
treatment team (teacher
home).
Treatment Integrity/


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iould decrease. In addition,
phase the participant
1 intervention. This
f the author and treatment
cipant that if he lies about his
ork, in the future, people will
11 be really in pain, and he


0% agreement occurred
e other member of the
or B.A. in school, parent in


'rocedural Reliability


The author observed the treatment on three
different occasions in the school and once in the
home to insure that the staff was executing the
procedures correctly. On each occasion, the treatment
was as stated in the procedure section above.
Design
We used a multiple baseline design across
setting. After the experimenter collected the baseline
data for four weeks, the team implemented the
intervention at home. The experimenter observed the


intervention delivered at the home by parent on one
occasion to ensure that the team delivered the
treatment with integrity. The parents were
implementing the procedure correctly. After several
days of intervening at home, the teacher and B.A.
executed the intervention at school. Again, the
experimenter observed on three different occasions to


ensure that the team rendered the treatment correctly.
While the teacher was supportive, the B.A. primarily
delivered the intervention in the classroom. On the
three occasions of observation, the B.A. implemented
the intervention correctly each time.
Results/ Discussions
Cautilli and Hantula (2001) predicted
functional assessment methodologies would offer
successful interventions for deception in general, and
malingering in particular. In testing the Cautilli and
Hantula (2001) prediction, we hypothesized that the
behavior would decrease after the functionally based
intervention occurred. When the intervention
occurred in the home, this was indeed the case and no
change occurred in the school. As indicated in figure
1, in the home, the mean rate of malingering was 2.75
episodes/ week with a standard deviation of .957


Figure 1. The rate of complains of illness across home and school settings.





5 Baseline Intervention

4 -

w3
- a) 3 -



21
E
0 0 -------

4-



0 - 3
E 0
C2V
0,- ------------------
1 -

0 - o
1 2 3 4 5 6 7 8 9 10







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prior to intervention. After the fourth week, the team
introduced the intervention and an immediate
reduction in malingering was evident. Post the
intervention phase in the home the rate of
malingering was zero over the course of the next six
weeks of the study. Next, the team implemented the
intervention at school. The prediction was that the
behavior in the school would also decrease. The data
verify this fact. As figure 1 indicates, in the school
baseline rate of malingering showed a mean of 3.33
episodes / week with a standard deviation of 1.211
over six-week period. The team began the
intervention in the sixth week and lasted for four
weeks. Post intervention the mean rate of occurrence
was immediately reduced 0.5 episodes / week with a
standard deviation of .577. In both cases, post
intervention data came to a near zero. Thus, this
study demonstrates a functional relationship between
malingering behavior and the intervention package.

A functional assessment combined with
behavioral and instructional interventions have much
to offer in the treatment of malingering in children.
The child in this study made rapid progress and
maintained it during the course of the study. The
family and school were pleased with the resulting
change in the child's behavior. In addition, informal
contact with the family has suggested that 3-weeks
post study, the child continued to show no difficulty
with malingering. No school follow up occurred due
to summer.

Limitations of the study are that the
behavior was of low frequency in occurrence. Since it
was low frequency not many data points were


collected. A second limitation was that we did not
think to collect data on the number of times that the
child did request help or request not to have to
complete the work. Informally, he did make several
such requests each week in different contexts.

According to Bienenfield (2003)
malingering adds $1050 in cost to the premiums of
typical American family. Since malingering has such
high impact to American society, the importance of
early identification, case formulation based on a
functional analysis, and intervention is critical. A
previous case study by Creer, Weinberg and Molk
(1974) showed that malingering was treatable by
behavioral interventions. Our study adds to this
literature. If replications of our study occur, than
social policy might build group contingencies that
select for honest behavior and against malingering.

References

American Psychiatric Association (APA)(2001). Diagnostic and
statistical manual of Mental disorders (4th Ed.-T.M.).
American Psychiatric Press, Washington DC. 683

Bienenfeld, D. (2003). Malingering.
http://www.emedicine.com/med/topic3355.htm

Cautilli, J.D. & Hantula, D. (2001). Defining the verbal specialist:
An adaptive evolutionary view of deception and
counter control. The Behavior Analyst Today, 2, 211-
221. www.behavior-analyst-online.org

Creer, T.L., Weinberg, E., & Molk, L. (1974). Managing a hospital
behavior problem: Malingering. Journal of behavior
therapy and experimental psychiatry, 5, 259-262.


239


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Goldfarh, O'Brien, & Krakow JOBA OVTP


CAN PRESCHOOLERS RESIST THE LURES OF KNOWN AND UNKNOWN
PERPETRATORS?: A PRELIMINARY EXAMINATION OF THE EFFICACY OF A
BEHAVIORAL ABDUCTION PREVENTION PROGRAM
Laurie Goldfarb and Richard O'Brien, Hofstra University, Elisa Krackow, Binghamton University, State University
of New York

Previous studies have examined whether preschool children can resist the lures of strangers but the present study included an
examination of preschoolers' ability to resist the lures of familiar individuals. Using a multiple baseline design across subjects,
preschoolers (N = 8) were approached by both stranger and familiar confederates. Results demonstrated that after abduction
prevention training, target verbal behavior increased. There was no effect of training on motor and reporting behavior.
Preschoolers verbally resisted the lures of stranger and familiar confederates at approximately equal frequency.


According to the National Incidence Studies
of Missing, Abducted, Runaway, and Thrownaway
Children (NISMART), an estimated 58,200 children
were abducted by nonfamily members in 1999.
Nearly half of the abducted children were victims of
sexual assault and in a small number of cases (less
than 100) were murdered. Approximately 4,300 of
the children were younger than 6 years old. They
accounted for nearly one-fifth of the most severe
kidnapping cases (Finkelhor, Hammer, & Sedlak,
2002). According to one large study, the majority of
abductions of children ages 3-5 occur by a familiar
adult with estimates of only 14% of preschool
abductions by strangers (Boudreaux, Lord, & Dutra,
1999). At school-age, increases in stranger abduction
occur as children are more frequently unsupervised
outside the home (Boudreaux et al.) Numerous
immediate and long-term psychological effects of
abduction have been reported (Boney-McCoy &
Finkelhor, 1996).

In many cases perpetrators do not abduct
children using violence or force. Rather, they
convince the child to accompany them willingly by
presenting the child with a lure or enticement (Poche,
Brouwer, & Swearingen, 1981). In abduction
simulation studies, 75% to 90% of children ages 3-7
Author Note
Elisa Krackow is now at the Department of Psychology,
West Virginia University.
This study was conducted as a doctoral dissertation at
Hofstra University by the first author under the direction of
the second author. We thank Brain Cox, Phyllis Ohr,
Howard Kassinove, and Kurt Salzinger for serving as
committee members.
Karen Chin, Andrew Corso, Susan Gaylord, Mike Hickey,
Jennifer Hoag, Suzanne Main, Tara Mandel, Michele Read,
Dan Rinaldi, Noreen Vail, and Wanda Vargas provided data
collection assistance. We are grateful to the parents and
children who participated in this study as well as the daycare
director and staff.
We thank Mark Wolery for providing us with the abduction
prevention program materials used in this study.
This study was funded by the Camelot Education Center.
Correspondence concerning this article should be sent to
Laurie Goldfarb, 121 Northern Parkway W., Plainview, NY
11803.


were easily persuaded to leave with a stranger (Poche
et al., 1981; Poche, Yoder, & Miltenberger, 1988).

In response to the concerns about child
abduction, a number of programs have been
developed to teach children abduction prevention
skills. The objective of abduction prevention
programs is to teach safe responses (i.e., verbal,
motor, and reporting responses) for children to use
when confronted by a stranger. A broad spectrum of
programs was implemented using several formats,
e.g. films, puppets, books, or role plays (Bromberg &
Johnson, 1997). Although a large number of
programs exist, there are few studies which provide
empirical evidence documenting their effectiveness
with preschoolers. A review of the literature reveals
that behavioral programs utilizing verbal rehearsal,
modeling, role-plays, praise, and feedback are the
most effective (Carroll-Rowan & Miltenberger, 1994;
Gast, Collins, Wolery, & Jones, 1993; Fryer, Kraizer,
& Miyoshi, 1987; Holcomb, Wolery, &
Katzenmeyer, 1995; Johnson, Miltenberger, Egemo-
Helm, Jostad, Flessner, & Gatheridge, 2005;
Marchand-Martella, Huber, Martella, & Wood, 1996;
Miltenberger & Thiese-Duffy, 1988; Miltenberger,
Thiesse-Duffy, Suda, Kozak, & Bruellman, 1990;
Olson-Woods, Miltenberger, & Foreman, 1998; Poche
et al., 1981; Poche et al., 1988) compared to
programs that administer training via a video or a
book (Carroll-Rowan & Miltenberger, 1994).
Moreover, studies with young school-aged children
that use behavioral plus in situ training, training in
the specific environmental situation in which they are
likely to be vulnerable to abduction, yielded more
effective results than those using behavioral training
alone (Johnson, Miltenberger, Knudson, Egemo-
Helm, Kelso, Jostad, and Langley, 2006; Johnson,
Miltenberger, Knudson, Egemo-Helm, Jostad, and
Langley, 2005).

Researchers have demonstrated that
outcomes are better when experts rather than parents
administer these programs (Miltenberger et al., 1990;


240


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Miltenberger & Thiesse-Duffy, 1988). Preschoolers
were able to maintain gains in motor behavior for
delays up to 4 months in some studies (Miltenberger
et al., 1990). However, in other studies preschool
children did not maintain gains in motor skills but
continued to resist verbally (Miltenberger & Thiesse-
Duffy, 1988). Researchers have also found that there
are individual differences in children's responses
such that training is not successful for some young
children (Fryer et al., 1987; Poche et al., 1991).
Providing additional training to those children who
did not initially acquire the necessary skills was not
effective for some children (Fryer et al.).
Assessment via in situ probes, those
conducted in naturalistic settings (e.g., school or
home) and without children's awareness that they
were being tested, is important because children do
not behave in a way that is consistent with their
verbal statements of what they should do in an
abduction situation (Carroll-Rowan & Miltenberger,
1994; Miltenberger et al., 1990; Olson-Woods et al.,
1998). This form of assessment allows researchers to
determine whether children would engage in safe
responses when encountering strangers in a real-life
situation.
According to Finkelhor et al. (2002), the
abductor is known to the child in 53% of actual
abduction situations. The current study is the first
attempt that we are aware of to determine whether
children can be taught to use abduction prevention
skills when encountering both unknown (i.e.,
strangers) and familiar adults. To date, researchers
have only assessed whether programs are successful
in teaching children to use abduction prevention
skills when encountering a stranger. Only Gast et al.
(1993) included some familiar people as suspects
during probes, but they did not ascertain whether the
program was differentially effective for familiar
people versus strangers. Rather, the results grouped
both types of suspects together. It is highly desirable
to teach children to also use abduction prevention
skills with familiar people (i.e., friends or
acquaintances, neighbors, persons of authority, and
caretakers or babysitters).
In this study a modified version of the
Holcombe et al. (1995) classroom-based behavioral
program was employed. The program included
verbal rehearsal, modeling, and role-plays designed
to teach children to resist the lures of strangers. Our
modification included telling the children not to go
with anyone but their mom, dad, or teacher and
adding scenarios that included instructions not to go
with familiar people without permission. This
program was selected for modification because


results demonstrated that all but one of the subjects
generalized learned behaviors to community settings
(park, bathroom, shopping center) at a variety of time
intervals. In addition, all but one of the children
performed the correct motor response of running
away within 3 seconds and approximately half
performed the verbal response during follow-up
assessments with varying time delays.
A multiple baseline across subjects
design was employed in the current study. Subjects
1-4 (Group 1) received training immediately
following the initial baseline probe, while Subjects 5-
8 (Group 2) waited for the first group to complete
training. Group 2 was then assessed a second time
before receiving training. All children received
abduction prevention training. They were assessed
using in situ probes at pre- and post-training, and at a
one-month follow-up. Each child received lures by
both unfamiliar confederates (i.e., strangers) and
familiar confederates. The number of children to
achieve the criterion of target verbal, motor, and
reporting responses based on children's responses to
in situ probes served as the dependent measures.
Children were expected to demonstrate an
increase in the three target responses (saying no,
moving away, and reporting the incident) across
stranger and familiar conditions, following the first
training series for Group 1 and only after the second
training series for Group 2. However, it was
hypothesized that teaching preschool children to
resist a familiar person would be more difficult than
teaching them to resist a stranger given their level of
cognitive development and their previous positive
experience with the familiar confederates.
In addition, all children were expected to
maintain an increase in the target responses across
stranger and familiar conditions at follow-up.
METHOD
Subjects
Eight 4- to 5-year-old children (4 boys, 4
girls), age range 4.0 to 5.3 years from the same
preschool were recruited via consent forms. The
consent forms were given to all children ages 4 and 5
in this school. The consent forms provided a
description of the study and asked that all parents
indicate on the form whether they did or did not grant
permission for their child to participate in the study
and return the form to the principal investigator.
Children represented a variety of ethnic backgrounds
(i.e., Caucasian n = 5; Hispanic n = 1; and African-
American n = 2) and were from primarily middle-
class backgrounds. None of the children had been
diagnosed with learning or attention difficulties


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according to parental report. Institutional Review
Board approval was obtained prior to the children's
participation in this study.

Design
A multiple baseline design across subjects
was employed so that Subjects 1-4 (Group 1)
received training immediately following the initial
baseline probe, while Subjects 5-8 (Group 2) waited
for the first group to complete training. Group 2 was
then assessed a second time before receiving training.
All children received abduction prevention training.
They were assessed using in situ probes at pre-
assessment in the school setting, post-assessment in
the school and home settings, and at one month
follow-up in the school and home settings. Each
child received lures by both unfamiliar confederates
(i.e., strangers) and familiar confederates, although
only type of confederate at a particular time point in a
particular location.
Dependent Variables. The number of
children to achieve the criterion of target verbal,
motor, and reporting responses based on children's
responses to in situ probes, served as the dependent
variables. The definition of each dependent variable
is as follows:
Verbal response: Respond to the
confederate by saying, "No, I have to go ask my
teacher (in the school setting/parent (in the home
setting)."
Motor response: Move toward the school
building/home for a minimum distance of 10 feet
within three seconds following either a verbal
response or the lure.
F,.. P. ,o i,, response: Report the fact that they
were asked to accompany the confederate to a teacher
or parent.
Children were scored either "yes" or
"no" as to whether they demonstrated the correct
verbal, motor, and reporting responses.
Measures
In situ probes were used to assess whether the
children were able to demonstrate taught abduction
prevention behavior. Assessment took place in both
the school and home settings, using the following
format: The teacher or parent brought the child
outside and then returned to the building on a
fictitious mission. A confederate approached the
child and presented one of five lure types: general,
authority, enticement, assistance, or conversational
(Holcombe et al., 1995). The lures are described in
Figure 1. Following the child's response, regardless


of whether it was correct or incorrect, the parent or
teacher reappeared and the confederate left.
Procedure

Abduction Prevention Training. The
abduction prevention training program used in this
study was adapted from Holcombe, Wolery, and
Katzenmeyer (1995). Training occurred at the
participating preschool in a classroom and was
administered by the first author. The trainer
instructed children in two groups of 4 preschoolers
each. During the first session, the trainer briefly
introduced training by: Explaining the objectives of
training ("you will learn what to do if a person other
than your mother/father/teacher asks you to go with
them"); Defined and provided examples of who is an
inappropriate person to leave with (including both
strangers and familiar people); Described the target
motor, verbal, and reporting behaviors, ("go to your
teacher/parent," "say, no, I have to ask my
teacher/parent").
Also during the first session, the trainer
asked the children to repeat the three rules (the target
behaviors), three times as a group. They were praised
each time. The motor behavior was taught as the first
rule, as it is considered the most important skill. The
investigator then modeled the target behaviors by
acting out an abduction scenario. When modeling the
target behaviors, the investigator provided a verbal
description of the behavior (e.g. "The first thing I am
going to do is move away from the person and go
back to the teacher. After I start to walk away I will
say that I have to ask my teacher." The reporting
response was modeled as well (e.g., No\\ I'm going
Figure 1: Lure Types and Examples
General lure: A simply stated lure posed in the form of a
question.
Would you like to go for a walk/ride in my car'
Authority lure: The confederate tells the child that an authority
figure approves.
Your teacher/mother/aunt wants you to take me home said it
was alright.
Enticement lure: The confederate offers the child candy, ice
cream, a surprise or some other desirable food or item.
I've got a nice surprise in my car. Would you hke to come with
me and see it'
Assistance lure: The confederate asks the child for help.
I lost my dog. Can you help me find him?
Conversational lure: The confederate engages the child in more
extensive small talk before employing one of the four previous
lures.

to tell my teacher.")
After modeling the appropriate behaviors,
the investigator verbally rehearsed the "rules" with
the children in the context of verbal examples of
abduction scenarios. Each child had two turns to
respond, and was praised for correct answers and


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given corrective feedback for incorrect responses.
The investigator then role-played the abduction
scenarios giving each child had one turn to
participate in a role-play. Again, praise and corrective
feedback were used to reinforce the target behaviors.
The investigator encouraged other group members to
pay close attention to the role-plays and provided
feedback as well.
During all phases of training, the
investigator used varying confederate types (familiar
and stranger, men and women, older and younger,
etc.) and different lures and settings. Subsequent
training sessions proceeded as follows: 1. Explained
content ("Today we are going to practice what we
learned yesterday.") 2. Reminded the children of the
three rules. 3. Simultaneously modeled and verbally
described the target behaviors one time. 4. Verbally
rehearsed the target rules using abduction scenarios
and asking each child one question. 5. Role-played
two situations with each child using the same
procedures as on the first day of training.
The first training session lasted
approximately 30 minutes, and subsequent
sessions were approximately 20 minutes each.
Training ended for each child when she had
demonstrated the target motor response for four
consecutive role-plays over two days and the target
verbal and reporting responses for two consecutive
role-plays over 2 days, with a minimum of 4 days of
training.
Assessment. Performance of the target
verbal, motor, and reporting responses was assessed
using in situ probes. Children in Group 1 received a
baseline assessment by one familiar and one
unfamiliar confederate. Children in Group 2 received
the same assessment as Group 1 plus an additional
baseline assessment (baseline #2) with a lure
presented by one stranger and one familiar
confederate. For post-training and follow-up
sessions, each child received a lure from one stranger
and one familiar person at each time point, but
stranger and familiar confederates were
counterbalanced by setting. If subject 1 was assessed
at the post-school assessment by a stranger, they were
assessed at the post-home assessment by a familiar
person. In Group 1, each child was assessed on five
occasions: 1 baseline (1 stranger, 1 familiar), 2 post-
training, 2 follow-up or six occasions in Group 2 six:
2 baselines (2 stranger, 2 familiar), 2 post-training,
and 2 follow-up assessments. The initial baseline
assessment occurred 3 days before the start of Group
l's training for all eight children. Group 2 received a
second baseline assessment 3 days prior to the start of
their training. Post-training assessments occurred


approximately 8 days following training (range 1-8
days, modal number = 8 days). Follow-up
assessments were approximately one month after
post-training assessments. Post-training and follow-
up assessments were also conducted near the child's
home to establish generalization across settings.
Baseline measures were included only at
school rather than at both school and at home because
an examination of available studies to date in which
abduction prevention skills were assessed at baseline
and baseline data were presented showed that it was
very rare for preschoolers to engage in abduction
prevention skills regardless of the setting in which
they were assessed before receiving training
(Holcombe et al., 1995; Marchand-Martella et al.,
1996; Miltenberger & Thiesse-Duffy, 1988; Olson-
Woods et al., 1998; Poche et al., 1981). Children in
these studies were assessed in a variety of locations,
including but not limited to, school, home, parks,
public libraries, stores, public restrooms, and public
libraries. For example, in the Olson-Woods et al.
(1998) study, 31 children were assessed at baseline in
one of three settings and none of these children
engaged in abduction prevention behaviors prior to
training. Moreover, in studies in which the same
children were assessed at baseline in multiple
locations (Holcombe et al., 1995; Marchand-Martella
et al., 1996; Poche et al., 1981), it was very rare for
children to demonstrate abduction prevention skills
prior to training.
Graduate students played the role of
confederates. They varied in terms of sex and
physical characteristics (e.g., height, hair color).
"Stranger" confederates were people unknown to the
children, and people with whom they have had no
former contact. "Familiar" confederates were people
who spent 4 hours within a one week period as a
volunteer in their preschool classroom. In the
classroom, the graduate students were called
"visitors" and wore an identifying pass. The
"visitors" engaged in a variety of activities with the
children (e.g., read and discussed a book; played
Bingo). The children learned the name of the visitor.
This method of familiarizing children with the
research assistant was used in Leichtman and Ceci,
1995.
Scoring. All verbal and motor responses
were scored by both the first author and the
confederate both in school and at home. Agreement
occurred when both observers scored the child's
verbal and motor responses identically for one
session. Inter-rater agreement was 100%. Reporting
responses were scored by the teacher or parent
depending on location.


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Results children reported

See Table 1. The results for Groups 1 and 2 that these differ
were combined for each assessment in the same cannot be interp
location (school vs. home) by adding the total more effective a
number of children who performed a particular target the ome setting
response across stranger confederate and familiar See Tal
confederate situations. The results show that children setting depicted

Table 2
Number of Children Who Performed Target Responses in the School Setting by
Perpetrator Type
Behavior Baseline Post-Training Follow-up Assessment
Stranger School Setting
Verbal 2/8 4/4 3/4
Motor 0 0 0
Reporting 0 1/4 0

Familiar School Setting
Verbal 1/8 0 4/4
Motor 0 0 0
Reporting 0 0 0
Note. Eight represents the maximum number for baseline. Four represents the maximum
number for Post-training and Follow-up. Numbers do not necessarily reflect the same
subjects across each time point.

demonstrated increases in performance of target
responses only after receiving the training program, follow-up verbal
with the greatest improvement being at school being a stranger. Only
the verbal behavior. Striking differences were found behavior at follow
across location of the probe. None of the 8 children See Tal
ran away from the confederate at school at any time. pattern emerged


Table 1
Number of Children Who Performed Target Response Across Stranger and Familiar Probes
Behavior Baseline Post-Training Follow-up Assessment
School Setting
Verbal 2/8 4/8 7/8
Motor 0 0 0
Reporting 0 1/8 0

Home Setting
Verbal --- 6/8 4/8
Motor --- 4/8 4/8
Reporting --- 6/8 7/8
Note. Eight represents the maximum number at all time points. Numbers do not necessarily
reflect the same subjects across each time point.


244


Table 3
Number of Children Who Performed Target Responses in the Home Setting by
Perpetrator Type
Behavior Baseline Post-Training Follow-up Assessment
Stranger Home Setting
Verbal - 3/4 2/4
Motor - 1/4 3/4
Reporting -- 4/4 4/4
Familiar Home Setting
Verbal - 3/4 2/4
Motor - 3/4 1/4
Reporting -- 2/4 3/4
Note. Four represents the maximum number for Post-training and Follow-up. Numbers do
not necessarily reflect the same subjects across each time point.


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JOBA-OVTP


In contrast, 4 of the same 8
children ran away at home on both
post-training and follow-up
probes. In addition, many more
children reported the incident
when approached at home, as
opposed to school. When
assessed at home, 6 children
reported the incident at post-
training, and 7 did so at follow-up.
When assessed at school, only one
child reported the incident at post-
training, and none of the 8
d it at follow-up. It should be noted
ences between home and school
reted to mean that the training was
t home given the lack of a baseline in


ble 2. The results for the school
separately by stranger and familiar
confederates showed that at post-
training, children were more likely
to engage in the verbal target
response when approached by a
stranger confederate than by a
familiar confederate. None of the
4 children displayed the target
response at school when
approached by a familiar
confederate at post-training, but
interestingly all 4 children did
engage in the target verbal
behavior when approached by the
familiar confederate at the 1-month
follow-up. Children were more
consistent in their post-training and
I responses when the confederate was
one child did not maintain the verbal
w-up.

ble 3. In the home setting, no clear
with respect to stranger vs. familiar
confederates. Children
demonstrated some abduction
prevention behavior regardless of
the familiarity of the confederate.

Discussion

This study was designed to
evaluate the effectiveness of an
abduction prevention program for
preschoolers. Eight preschool
children were trained to exhibit the
following abduction prevention
behaviors when asked to
accompany either a stranger or a


I







JOBA OVTP Volume 1, Issue 3


familiar person other than a family member: verbal
response (say "no"), motor response (move away),
and reporting response (tell a parent or teacher).
Children's performance of the target
responses increased moderately when the target
behavior was verbal reporting of the confederate's
approach at school. Interestingly, some children who
demonstrated skills at baseline were not consistent in
their responses across baseline, post-training, and
follow-up assessments. Other children did not
engage in the verbal target behavior immediately
after training, but then verbally reported the incident
at the 1-month follow-up. When the data from post-
training and follow-up assessments were combined,
children were equally likely to verbally report being
approached at school regardless of whether the
confederate was a stranger or familiar to the child.
The training was not effective in teaching children to
run away or report to a teacher that they had been
approached. One likely explanation for this
occurrence is children's perception of safety. The
probes conducted at school took place in an enclosed
playground, which may have fostered an even greater
sense of security, as this area may only be accessed
from the school building. In addition, children were
used to being taken out of class for services such as
speech therapy. Although these providers may be
unfamiliar to the child at first, accompanying them is
sanctioned behavior. Therefore it may be that
children require a minimum level of fear to prompt
the abduction prevention behavior of moving away.
As it may not be desirable to instill fear within the
school setting, an alternative would be in vivo
training on the playground as opposed to training in
the classroom as was done in the current study. This
additional training may have improved the children's
performance. Previous research demonstrates that
behavioral plus in vivo training was effective for
preschoolers in learning and maintaining abduction
prevention skills (Johnson et al., 2005). Similarly,
several studies show that the inclusion of in vivo
training benefits preschoolers (Gast et al., 1993) and
school-aged children's (Johnson et al., 2005, 2006)
acquisition of abduction prevention skills.
Regarding the home generalization data, a
significant limitation of this study is lack of a
baseline. This renders the better performance of
children in the home setting for verbal, motor, and
reporting behaviors uninterpretable. Therefore, future
research should include baseline assessments in all
locations to be used as generalization measures.
There were some noteworthy responses that
occurred during the study and deserve discussion. At
times, it seemed that although the children were


cognizant of the correct target response, they were
unable to translate that knowledge into behavior. For
example, for both post-training and follow-up home
assessments, Subject 8 performed both verbal and
reporting responses, but failed to exhibit the correct
motor behavior. However, when reporting the
incident to her parent she said, "I forgot to back
away." She had remembered the skill, but was
unable to utilize it when confronted with an in vivo
test. There was also more than one occasion on which
a child ran away quickly, but did not perform the
verbal response. Although objectively they failed to
provide all three target responses, these children
successfully avoided abduction by leaving the
vicinity immediately.
Future research with young children should
continue to attempt to train children to resist the lures
of familiar adults given that preschoolers are more
likely to be abducted by familiar people than by
strangers. A larger-scale study with stranger vs.
familiar confederates as a between-groups variable is
warranted. It is recommended that training in the
verbal response and reporting responses be
eliminated such that training only in the motor
response should be undertaken; the motor response is
the most important in terms of children escaping
from an abduction situation. Even in the between-
groups design, baseline measures should be taken and
analyses run including and excluding children who
demonstrated the behavior at baseline. In addition,
given children's spontaneous performance at the 1-
month follow-up, at least two assessments at each
time point will be helpful in determining whether
children do in fact demonstrate the behavior at that
specific time point. This will better help us to
determine children's ability to resist the lures of
stranger versus familiar confederates.
In closing, although training children in
abduction prevention skills is important for children's
safety, abduction prevention falls into the larger
category of pediatric injury prevention. Pediatric
injury prevention researchers have argued that
families, particularly parents, play a major role in in
the prevention of children's injuries including
monitoring risky situations. These same family
processes, including supervision, communication,
discipline, and teaching of rules have been shown to
serve as risk factors for maltreatment related injury
(Peterson & Stern, 1997). These authors suggest that
these same processes might impact risk for
nonmaltreatment injury. Therefore, they advocate for
a broader-based approach to injury prevention that
examines family socialization processes. Teaching
parents to socialize injury prevention skills either
alone or in conjunction with abduction prevention


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training programs for children may yield more
promising results than abduction prevention training
programs alone.


References


Boney-McCoy, S., & Finkelhor, D. (1996). Is youth victimization
related to trauma symptoms and depression after
controlling for prior symptoms and family
relationships? A longitudinal, prospective study.
Journal of Consulting and Clinical Psychology, 64,
1406-1416.


Boudreaux, M. C., Lord, W. D., & Dutra, R. (1999). Child
abduction: Aged-based analyses of offender, victim,
and offense characteristics in 550 cases of alleged child
disappearance. Journal ofForensic Science, 44, 539-
553.


Boudreaux, M. C., Lord, W. D., & Etter, S. E. (2000). Child
abduction: An overview of current and historical
perspectives. Child Maltreatment, 5, 63-71.


Bromberg, D. S., & Johnson, B. T. (1997). Behavioral versus
traditional approaches to prevention of child abduction.
School Psychology Review, 26, 622-633.


Carroll-Rowan, L. A., & Miltenberger, R. G. (1994). A
comparison of procedures for teaching abduction
prevention to preschoolers. Education and Treatment of
Children, 17, 113-128.


Finkelhor, D., Hammer, H., & Sedlak, A. J. (2002). Nonfamily
abducted children: National estimates and
characteristics. Washington, DC: Office of Juvenile
and Delinquency Prevention.


Fryer, G. E., Kraizer, S. K., & Miyoshi, T. (1987). Measuring
children's retention of skills to resist stranger abduction:
Use of the simulation technique. ChildAbuse and
Neglect, 11, 181-185.


Gast, D. L., Collins, B. C., Wolery, M., & Jones, R. (1993).
Teaching preschool children with disabilities to respond
to the lures of strangers. Exceptional Children, 59, 301-
311.


Holcombe, A., Wolery, M., & Katzenmeyer, J. (1995). Teaching
preschoolers to avoid abduction by strangers:
Evaluation of maintenance strategic. Journal '
and Family Studies, 4, 177-192.


Johnson, B. M., Miltenberger, R. G., Egemo-Helm, K., Jostad, C.,
Flessner. C., & Gatheridge (2005). Evaluation of


behavioral skills training for teaching abduction-
prevention skills to young children. Journal of Apphed
Behavior Analysis, 38, 67-78.


Johnson, B. M., Miltenberger, R. G., Knudson, P., Egemo-Helm,
K., Kelso, P., Jostad, C., & Langley, L. (2006). A
preliminary evaluation of two behavioral skills training
procedures for teaching abduction-prevention skills to
schoolchildren. Journal ofApphed Behavior Analysis,
39, 25-34.


Leichtman, M.D., & Ceci, S. J. (1995). The effects of stereotypes
and suggestions on preschoolers' reports.
Developmental Psychology, 31, 568-578.


Marchand-Martella, N. E., Huber, G., Martella, R. C., & Wood, W.
S. (1996). Assessing the long-term maintenance of
abduction prevention skills by disadvantaged
preschoolers. Education and Treatment ** . . 19,
55-68.


Miltenberger, R. G., & Olsen, L. A. (1996). Abduction prevention
training: A review of findings and issues for future
research. Education and Treatment . . .19, 69-
82.


Miltenberger, R. G., & Thiesse-Duffy, E. (1988). Evaluation of
home-based programs for teaching personal safety
skills to children. Journal ofApphed Behavior Analysis,
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Miltenberger, R. G., Thiesse-Duffy, E., Suda, K. T., Kozak, C., &
Bruellman, J. (1990). Teaching prevention skills to
children: The use of multiple measures to evaluate
parent versus expert instruction. Child & Family
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Olsen-Woods, L. A., Miltenberger, R. G., & Foreman, G. (1998).
Effects of correspondence training in an abduction
prevention training program. Child & Family Behavior
Therapy, 20, 15-34.


Peterson, L., & Stem, B. L. (1997). Family processes and child risk
for injury. Behaviour Research and Therapy, 35, 179-
190.


Poche, C., Brouwer, R., & Swearingen, M. (1981). Teaching self-
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BEYOND CRIME AND PUNISHMENT:
RECONCEPTUALIZING THE SCHOOL DISCIPLINARY LADDER THROUGH A PBS
MODEL
R. Anthony Doggett, Mississippi State University, J. Dale Bailey, Fluency Plus, Inc., Kristin N. Johnson-Gros,
Mississippi State University

The applied science of positive behavior supports (PBS) uses empirically-based educational and systems change methods to
expand an individual's behavioral repertoire and minimize the occurrence of problem behavior (Carr et al., 2002). PBS was
initially developed as an alternative to punishment-based interventions for aberrant behaviors displayed by individuals with
developmental disabilities (Netzel & Eber, 2003). However, PBS strategies have been extended to include school-wide proactive
intervention approaches (Sugai & Homer, 2006). The purpose of this manuscript is to describe PBS implementation as
experienced by a rural southeastern school district. Outcomes and implications will be addressed.


Introduction
School personnel are responsible for
developing and maintaining important academic and
socio-behavioral skills for their students (Lewis-
Palmer & Barrett, 2007) with this expectation being
formally expressed in the No Child Left Behind
(NCLB) legislation passed in 2002. Specifically,
NCLB requires states to demonstrate that the public
schools are progressing each year in the academic
subject areas of reading and mathematics. Schools
are also expected to reduce the achievement gap
between typically developing students and specific
populations (e.g., students enrolled in special
education, students of minority status, or students of
limited English proficiency). Finally, the legislation
focuses on creating safe school environments and
increasing the quality of teachers.
The display of aberrant and violent behavior
in schools continues to be a major concern for school
personnel despite the passage of federal legislation
aimed at creating safe, drug-free environments. For
example, the National Center for Educational
Statistics (2006) reported some alarming results with
regard to the display of problem behavior in schools.
The overall rate of violent incidents (e.g., rape,
sexual battery, physical attack or fight with and
without a weapon, threat of physical attack with or
without a weapon, and robbery with or without a
weapon) was 31 incidents per 1,000 students. In
addition, 52% of all schools reported at least one
student threat of physical attack without a weapon
with another 9% of schools reporting a threat with a
weapon. Middle schools (43%) were more likely to
report incidents of student bullying than high schools
or elementary schools. Seventy-seven percent of
schools with an enrollment of 1,000 or more students
reported at least one incident of the distribution,
possession, or use of illegal drugs. Forty-one percent
of schools indicated that out-of-school suspension
lasting five or more days was used for students


involved in the use or possession of a weapon other
than a firearm or explosive device. Finally, the three
most common factors listed as limiting school
personnel's ability to reduce or prevent crime
included: (1) lack of or inadequate alternative
placements or programs for students displaying
disruptive behavior, (2) inadequate funding, and (3)
federal, state, or district policies on disciplining
students in special education.
The usual practice in most schools is to
develop a "get touch" or "zero tolerance" approach to
disciplining students exhibiting problem behavior
(Sugai & Homer, 2006). Fostering the zero tolerance
practice is the undisputed assumption that the use of
punishment techniques in isolation will change
behavior (Colvin, Kame'enui, & Sugai, 1993). The
traditional school discipline ladder typically relies on
the use of repeated warnings, reprimands, loss of
privileges, corporal punishment, in-school and after
school detention, in-school and out-of-school
suspension, and expulsion to address behavioral
infractions. Unfortunately, the traditional approach is
highly reactive in nature and often treats the student
as an individual who has displayed some "crime" that
needs to be addressed through punitive consequences.
The flawed assumption is that the student will learn
the proper ways of behaving in order to avoid the
consequences outlined on the traditional discipline
ladder. However, researchers have discovered that
such approaches are ineffective for students
displaying chronic behavioral concerns and often
exacerbate the display of antisocial behavior in these
students (Lewis, Sugai, & Colvin, 1998; Mayer,
1995). In fact, Mayer noted that high rates of
problem behavior in schools were closely associated
with punitive disciplinary strategies, lack of clarity
regarding rules, expectations, and consequences,
limited staff support, and failure to respect and
provide accommodations for individual differences.
Additionally, Lipsey (1991) found that the least
effective responses to disruptive behavior in schools


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were the use of traditional counseling and
psychotherapy and punitive discipline strategies.
Unfortunately, punitive disciplinary strategies seek to
remove the student from the educational environment
depriving them of important educational
opportunities. As a result, many of these students
simply drop out of school due to the lack of
environmental support to address their academic and
behavioral deficits (Colvin, Kame'enui, & Sugai,
1993).
Given the aforementioned concerns, the use
of more proactive, comprehensive strategies designed
to teach prosocial behavior in addition to reducing
the occurrence of problem behavior need to be
implemented in public schools. The authors are not
advocating for complete removal of the traditional
strategies used to discipline students who exhibit
problem behaviors that disrupt learning. However,
they are suggesting that the strategies need to be
redesigned in order to make the problem behaviors
more ineffective, inefficient, and irrelevant (Carr et
al., 2002; O'Neill et al., 1997). In addition, the
philosophy of school personnel within the
educational system has to be reconceptualized so that
they view disciplinary strategies as teaching
techniques designed to equip the student with
replacement behaviors that can be reinforced when
properly displayed. In other words, educational
environments must be rearranged so that students are
directly taught expected behaviors, provided on-
going opportunities to practice the display of desired
behaviors, and receive frequent and contingent
reinforcement for the display of the prosocial
behaviors that they have learned (Gresham, Sugai, &
Homer, 2001; Sugai & Homer, 2006; Walker,
Cheney, Stage, & Blum, 2005). Therefore, the
purpose of the manuscript will be to describe the
changes to the disciplinary procedures of a rural
school district using a positive behavior intervention
and support (PBIS) model. Outcomes from these
changes will be discussed and important
considerations for implementation of PBIS strategies
will be addressed.
Positive Behavior Supports
Positive behavior supports (PBS) is an
applied science that uses empirically-based methods
to redesign important environments in the
individual's life in order to expand their behavioral
repertoire (Carr, et al., 1999; Koegel, Koegel, &
Dunlap, 1996). As such, PBS is implemented to
improve the individual's quality of life while
preventing or reducing his or her performance of
problem behavior at the same time (Carr et al., 2002;
Sugai & Homer, 2006). Carr and colleagues (2002)


have suggested that positive behavior includes "all
those skills that increase the likelihood of success and
personal satisfaction in normative academic, work,
social, recreational, community, and family settings.
Support encompasses all those educational methods
that can be used to teach, strengthen, and expand
positive behavior and all those systems change
methods that can be used to increase opportunities for
the display of positive behavior" (p. 4).
Foundation for PBS
At the individual level, PBS has emerged
from three important literature bases including (a)
applied behavior analysis, (b) the
normalization/inclusion movement, and (c) person-
centered values (Carr et al., 2002). Researchers in
the field of applied behavior analysis over the past 35
years have provided a firm foundation for PBS
(Sugai & Homer, 2006). Applied behavior analysis
has been defined as "the science in which tactics
derived from the principles of behavior are applied
systematically to improve socially significant
behavior and experimentation is used to identify the
variables responsible for behavior change" (Cooper,
Heron, & Heward, 2007, p. 20). One of the most
important contributions of applied behavior analysis
to PBS has been the development of behavioral
assessment strategies, called functional assessment
and analysis, designed to identify the function or
purpose of the performance of problem behavior in
order to re-design the environment in order to teach
the individual alternative means (i.e., replacement
behaviors, communication strategies) using
empirically-based methods to obtain the same
motivating events for displaying the pro-social
behaviors (Carr et al, 2002). The field of applied
behavior analysis has also provided other important
educational concepts for implementation within the
conceptual framework of the PBS model including
the three-term contingency, identification of
important antecedent events (i.e., discriminative
stimulus, establishing operation, setting event),
stimulus control strategies (shaping, fading),
differential reinforcement contingencies, and
generalization and maintenance procedures (Carr et
al., 2002; Miltenberger, 2008).
PBS also subscribes to the principle of
normalization suggesting that individuals with
disabilities should reside in the same environments
and have access to the same opportunities as
individuals without identified disabilities with regard
to home, school occupation, recreation, and
socialization (Carr et al., 2002). As such, the
principle of normalization includes the movement
toward inclusion of students with disabilities into the


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general education classroom with the appropriate
supports needed for them to be as successful as
possible in such environments. Such activities
require that school systems modify their existing
structure so that the specialized supports required by
these students are fully integrated and coordinated
with general education strategies in local schools
(Sailor, 1996).
Finally, PBS emphasizes a person-centered
values perspective when implementing educational
services. Carr and colleagues (2002) indicated that
three interrelated processes serve to drive this
perspective. First, person-centered planning is
implemented where the unique needs of the
individual are constantly considered when examining
which services will be needed to assist them in
developing their full potential. Second, a focus on
self-determination is emphasized where choice
provision, problem solving, goal setting, self-
management, self-instruction, and self-advocacy are
supported in order to empower the individual.
Finally, the use of person-centered planning
incorporates the use of wrap-around services to
develop plans that are needs-based rather than
service-driven. Carr et al. suggested that such a
wrap-around approach address important domains
including familial and social supports, living
situations, financial issues, educational or vocational
needs as well as health and wellness, legal, cultural,
and safety issues. As such, the guiding premise for
the use of this approach is that the performance of
problem behavior will be reduced or eliminated when
the person's quality of life is improved by meeting
their individual needs (Carr et al., 2002).
System Level PBS Models
In recent years, PBS has extended beyond
the individual level to a more systemic level (Baker,
2005). For example, Walker et al. (1996) first
presented a model of school-based prevention
strategies for students displaying aberrant behavior
based on models used by the U.S. Public Health
Service for disease prevention. The model later
evolved into the Effective Behavior Support (EBS)
Model developed by Lewis and Sugai (1999) where
EBS was described as a continuum of PBS support.
A similar model has been presented by Sugai,
Sprague, Homer, and Walker (2000). Finally, Sugai
and Homer (2002; 2006) have discussed a model of
School-Wide Positive Behavior Support (SWPBS).
Despite the different presentations, all
models share a common theme in which a three-
tiered intervention approach is discussed where the
level of supports increases based on student need and
display of problem behavior. In addition, each model


represents a system-wide change where important
decisions are guided by data-based decision-making
activities. As such, the models include primary
prevention strategies aimed at preventing the
occurrence of problem behavior as well as secondary
and tertiary strategies aimed at reducing the
occurrence or impact of disruptive behavior (Sugai &
Homer, 2006). Tier I or primary prevention
strategies are implemented for all students within the
system across all school settings (e.g., classroom,
halls, cafeteria, recreational settings) and involves
school, family, and community members (Sugai &
Homer). Specific universal strategies include
teaching social and character education skills,
providing frequent opportunities for the attainment of
differential reinforcement for the display of
appropriate behavior, and designing and
implementing a comprehensive continuum of
discipline that seeks to discourage and reduce the
occurrence of problem behavior (Colvin, Kame'enui,
& Sugai, 1993; Lewis & Sugai, 1999). Such
strategies should address the needs of approximately
75% to 85% of the population (Lewis & Sugai).
Tier II or secondary prevention strategies are
often characterized as more intensive and typically
require more adult attention and monitoring (Sugai &
Homer, 2006). Services are usually provided to a
small group of students needing more in depth
instruction for behavioral and/or academic skills
deficits. As such, secondary prevention strategies are
typically required by 10-15% of the student
population. Finally, tier III or tertiary prevention
strategies are highly individualized and usually
require the implementation of function-based
behavioral support methods. In addition, personnel
who develop positive behavior support plans for
students referred at this level often require
specialized training and competence to develop the
comprehensive behavior intervention plans utilizing
wrap-around services that are designed to be person-
centered (Sugai & Homer).
Essential Components of School-Wide Positive
Behavior Support
Colvin (1991) has clearly and concretely
identified nine essential components that are needed
for proper implementation of school-wide positive
behavior support. The components will be briefly
reviewed here. First, schools must clearly identify
and state the purpose of school-wide discipline.
School personnel must personally adopt the
philosophy of PBS and school systems must make
this philosophy part of the mission statement.
Second, school personnel must clearly develop and
post school-wide expectations. The expectations


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should be brief in number and use proactive language
(i.e., tell students what to do as opposed to what not
to do) and should be posted in all important
environments (e.g., classroom, hallways, cafeteria,
recreational areas). Third, schools must create
school-wide structures that differentially reinforce the
performance of expected behaviors. Reinforcement,
by definition, involves the delivery of identified
reinforcers that are designed to increase the future
probability that the expected or desired behaviors will
be displayed again in the future (Miltenberger, 2008).
As such, school personnel must frequently (i.e.,
hourly, daily, weekly) provide reinforcement to
individuals displaying the behaviors consistent with
the identified expectations to create the contrast
needed to prevent or reduce the occurrence of
problem behavior. Fourth, in addition to reinforcing
the display of appropriate behavior, schools are now
realizing that they are going to have to teach
important behavioral skills. As such, schools should
incorporate the inclusion of various social skills or
character education programs designed to actively
teach pro-social behavior. Fifth, schools must clarify
those behaviors that are managed by staff versus the
behaviors that are managed by administrative
personnel. School principals are expected to be an
instructional leader. However, they often end up
serving as the primary disciplinarian in schools where
all referrals are sent to the office. Such practices
greatly reduce the principal's opportunities to model
instructional practices for staff and reinforce their
implementation of effective educational practices. In
addition, referred students often miss important
educational material while waiting to be addressed by
the principal. Sixth, opportunities should be provided
for staff to work together to address minor problems.
Staff development and in-service opportunities must
be provided throughout the year to assist staff in
learning the PBS approach to discipline and effective
strategies for assisting each other in implementing the
empirically-based procedures. Such activities must
move beyond the traditional "train-and-hope" model
to one of on-going consultation for staff who are still
experiencing difficulty managing students with
behavioral support needs (Sugai & Homer, 2006).
Seventh, a continuum of structures must be in place
to address serious office referrals. As mentioned
previously, the authors are not advocating the
removal of disciplinary strategies typically included
on the traditional discipline ladder. However, such
strategies must be redesigned to increase school
safety and address the behavioral needs of students
displaying the aberrant behavior. Eighth, resources
should be designed to assist students displaying
chronic behavioral concerns. Qualified and certified
personnel should be hired that can conduct functional


behavioral assessments and develop comprehensive
behavioral intervention plans from a person-centered,
wrap-around approach. Alternative programs and
schools must be redesigned to provide remedial
academic and vocational programming in concert
with important individualized behavioral
programming. Ninth and finally, recordkeeping
procedures should be developed and monitored to
readily track student behavioral and academic
progress across all environments. In other words, all
decisions should be data-driven and based on an
evaluation of outcomes derived from appropriate
implementation (i.e., adequate levels of treatment
integrity) of these nine components.
Research Supporting School Wide Positive
Behavior Support
The literature base for school-wide positive
behavior support implementation and outcomes has
been steadily increasing over the past several years
with articles on the topic being published in special
mini-series on building effective behavior supports in
journals such as the Journal of Positive Behavior
Interventions, Psychology in the Schools, and School
Psychology Review. Applications of school-wide
positive behavior supports has occurred in rural,
urban, and sub-urban settings across elementary,
middle, and high schools (Bohanon et al., 2006;
Colvin & Fernandez, 2000; Ervin, Schaughency,
Matthews, Goodman, & McGlinchey, 2007; Johnson-
Gros, Lyons, & Griffin, in press; Lewis, Powers,
Kelk, & Newcomer, 2002; Lohrmann-O'Rourke,
Knoster, Sabatine, Smith, Horvath, & Llewellyn,
2000; McCurdy, Mannella, & Eldridge, 2003;
Nersesian, Todd, Lehmann, & Watson, 2000; Netzel
& Eber, 2003; Sadler, 2000; Safran, 2006; Scott,
2001; Warren et al., 2003) and as part of state-wide
initiatives (Chapman & Hofweber, 2000; Lewis-
Palmer & Barrett, 2007; Nakasato, 2000; Shannon,
Daly, Malatchi, Kvarfordt, & Yoder, 2001). In
addition to the evaluation of the implementation of
the different PBS components, recent articles have
discussed important outcome measures including
evaluation of data from the school-wide evaluation
tool (SET; Homer, Todd, Lewis-Palmer, Irvin, Sugai,
& Boland, 2004), school-wide benchmarks of quality
(Cohen, Kincaid, & Childs, 2007) staff coaching
activities (Scott & Martinek, 2006), staff and student
time engaged in disciplinary procedures (Scott &
Barrett, 2004) and office discipline referrals (ODR;
Clonan, McDougal, Clark, & Davison, 2007; Irvin et
al., 2006; Walker, Cheney, Stage, & Blum, 2005).
Given the positive outcomes of these investigations
and the level of support for implementation of
school-wide positive behavior support strategies at
the district and state levels, it is not surprising that


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implementation of school-wide PBS practices is
occurring in over 4,000 schools across the United
States (Cohen, Kincaid, & Childs, 2007).

An Example Implementation of School Wide
Positive Behavior Support

The following section of the manuscript
discusses the implementation of a school-wide PBS
initiative in a rural school district in the southeastern
region of the United States. Specific attention will be
given to the modification of the traditional school
disciplinary ladder in order to transition from a
reactive, punitive approach to a more proactive,
teaching approach designed to be fostered by the
delivery of reinforcement for the display of pro-social
behavior and revision of typical disciplinary
consequences (e.g., in-school suspension, out-of-
school suspension, alternative programming) for the
display of problematic behavior. Outcomes and
important issues for implementation are also
addressed.

School District Information

The public school district educates more
than 3,000 students with over 84% of minority status
with 100% of students in the schools that house
grades K-8 qualifying for free lunch. Approximately,
74% eat free or reduced lunch at the high school
level. There are five schools and an alternative
school located within the district. Specifically, three
elementary schools are divided into the grades of K-6
with the middle school incorporating grades 7-8, and
the high school housing grades 9-12. In addition, the
high school also has a Business and Technology
branch. The inclusion of PBS strategies was part of a
larger health and wellness project in the district.
Although PBS is used nationally, this particular
school district uses Positive Behavior Interventions
and Supports (PBIS) to describe their model of
behavioral support. PBIS strategies were included
because district administration were concerned about
the number of referrals leading to the loss of
educational instruction time for students and staff and
the continued use of reactive disciplinary strategies
by staff (i.e., in school suspension, out of school
suspension). As such, we outline the procedural
implementation of PBIS strategies designed to
address these concerns.

Implementation of School Wide PBIS Strategies

Conceptually, the primary essential
component of the PBIS model is a system of
proactive and primary prevention strategies that are
consistently implemented at both the classroom and
school wide levels (Sugai & Homer, 2006). Figure 1


Figure 1. Revised disciplinary ladder incorporating PBIS
strategies.
Hierarchal Model f Atds an lmging Problem Behavr Pattern
L-dL: AhetiTreSdScolPlacamnt
Significant chrome potter ofmiscadact
Threab taad taffweapon g posessi Y hCart
One ea placamnt folowup
Daily acade andehavial support po sible pacement
Weey- imtonag adi vie ofpmrges inAOP

LeaV: InSdmolA.nu.tveProgrm
45 day sef-ontied placment
Addresa habitual dimptl ,asalti ntmidation Youthcort
Contmima cre acade c tion fre
Mahe mimtiw fation-based bdhool uPtrt1
Wrap amrd sanamp
Strategic taaitto lnaiung backto regular clr o
I
La-dIV: 1Scld Spaim (ISS)
Off c.pu settmg
Addess majoroffeues BenFormal
Irweasad ~ aeml rnem mne Interverion
nstctiomally roriate acamc l11 pachee
Inte ve suppleme l social AllshIts aies

L a'dTim: s.WladyDeltin
Mals up m-ad mas tmtia, tie.asgM awhen ma S IS
Repeabhtd a mowatnotn mqa Rnses Rffer to
SupreJnmtl arl ti11< fhact wnnan ISTI

L eadl Un IScml DA~ttikm (ISD)
Tacher-nmnaged bnef bnout
to ad&das ceatied- amomsiarr
r4&nm-sdvig a-ct-ly
SQckrethn lto m.stmctiA nmn it

Led I: fftie PresRmeio Strtelies
Effective schodlldass-r der pol ives fltegie
High ate of acdetnc sac-easr' flemtar t
Paimtavmimty sppot
Actaven supetisimrntiamoflf ard lkeepig


displays the revised discipline ladder that will be
discussed in the following sections.

Initially, to address this PBIS component,
school based teams were developed in each
participating building in K-12 to promote schoolwide
PBIS. Each school-based team was then trained on
the PBIS model by a consulting school psychologist
across three separate training modules. The training
sessions included an overview of the PBIS
philosophy, review of PBIS components including (a)
developing a school mission, (b) establishing and
teaching behavioral expectations, (c) developing
classroom and school-wide incentive programs to
promote and reinforce pro-social behavior patterns,
(d) implementing district-adopted strategies designed
to address problem behavior patterns (i.e. proactive
discipline hierarchy), and (e) recording methods for
monitoring school wide discipline data.

Prior to district-wide implementation, each
school-based team also developed a student
handbook of including PBIS-based procedures
covering specific behavioral expectations across all
school settings (i.e., school wide, classroom, and
non-classroom settings) and an overview of


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consequence strategies for addressing both
appropriate and problematic student behavior. In
addition, each school-based team developed a
dichotomy to differentiate which problem behaviors
were to be managed by teachers and administrators.
Finally, a day long district-wide PBIS kick-off was
conducted in the fall by Dr. Geoff Colvin on the first
day of teacher training during the first semester of
district wide PBIS implementation. This training was
designed to inform staff of overall PBIS philosophies
and specific classroom-based strategies including
using teacher attention effectively, developing and
teaching proactive classroom expectations, routines
and procedures, implementing limit setting
procedures, using precision requests to gain student
compliance, managing disrespectful/confrontational
behavior, and recognizing and managing student
agitation. To complement the district-wide training,
each school-based team conducted staff development
sessions with all staff members to review
expectations regarding the implementation of
classroom- based management strategies, as well as,
a review of the newly adopted proactive model of
consequence strategies adopted by the school board
to address various levels of problem behavior
patterns.
Again, primary tenets of the PBIS model
focuses on providing staff with effective techniques
and primary prevention strategies to effectively
manage the behavior of the majority of students at
tier I (Sugai & Homer, 2006). With this in mind,
during the first two weeks of school and throughout
the school term, each staff was directed by their
building principals to actively teach classroom
expectations, procedures, and routines. In addition to
classroom-based management strategies (e.g.,
systematic ignoring, in-class time out, delivering
precision requests to gain compliance, recognizing
and diffusing anger and agitation), each staff member
in grades K-6 was also required to develop a
classroom-based positive incentive program designed
to reinforce students who demonstrated acceptable
levels of conduct. Finally, each school based team
(excluding grades 9-12) developed various school-
wide incentive programs designed to reinforce
individual students on a monthly basis and/or at the
end of each grading period who demonstrated
acceptable conduct. The incentive programs included
school wide dances, field trips, and monthly behavior
celebrations.
Other school-wide strategies and supports
included daily character education in grades K-6 in
each classroom using the Second Step violence
prevention curriculum (1992), which is designed to
assist students in developing skills such as such as


empathy, anger management, impulse control,
cooperation, respectful behavior, and problem
solving. Students also learn to recognize and respect
people with different backgrounds, perspectives, and
ethnicities. In addition, credentialed positive
behavior support specialists were employed in each
to building to assist with managing the overall PBIS
effort and to provide ongoing direct intervention and
support services for behaviorally at-risk youth and
the educational personnel responsible for teaching
them.
Primary prevention strategies as mentioned
above have each been empirically validated to
effectively manage problem behavior (Sugai &
Homer, 2006; Walker et al., 1996). However, in
contrast to the punishment-based strategies employed
in many schools to address problem behavior
patterns, the following consequence strategies are
designed to reduce or eliminate problem behaviors
while also teaching students more appropriate
replacement behaviors (Colvin, Kame'enui, & Sugai,
1993; Lewis & Sugai, 1999).
In School Detention
Although the majority of students respond to
effective classroom-based management strategies,
there continues to be a percentage of students who
require supplemental strategies that are designed to
teach and help to maintain prosocial behavior
patterns (Sugai & Homer, 2006). In School Detention
(ISD) is a schoolwide version of a time out procedure
where each of the school buildings in grades K-12
have designated an area supervised by a trained
paraprofessional where students are required to report
for 15-20 minutes (grades K-6) and/or for the
remainder of the class period (grades 9-12) as the
result of continued noncompliance in the classroom.
All staff members were trained to use effective
instruction giving (e.g., precision requests) and limit
setting procedures prior to referring students to the
ISD setting. For example, after failing to respond to
an appropriate redirection, students were then given a
choice of complying with the adult's request or being
referred to ISD. In cases where the student complied
appropriately, staff members were trained to
acknowledge student cooperation through social
praise or other reinforcement procedures. However,
when students failed to comply with a second
redirection, they were provided with a short referral
form and directed to report to the ISD setting. The
procedure was taught to all students at the beginning
of the school term.
Upon arriving to the ISD setting, students
were required to complete a problem-solving activity
designed to allow for them to process the problem


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situation. That is, students were required to complete
an activity that asked the following questions (a)
What classroom behavioral expectations) did I
violate? (b) What specific class rules) did I violate?
(c) How did my misbehavior affect the learning of
others? (d) How did my behavior effect my ability to
learn?,(e) How did my behavior effect my teacher's
ability to teach?, and (f) What is my plan for
changing my behavior next time? Younger students
and students who had reading and/or writing skill
deficits completed the problem-solving activity with
the assistance of the ISD supervisor. Once the student
demonstrated cooperative behavior and completed
the problem-solving activity, he or she was directed
to report back to their regular classroom. All referrals
to ISD were recorded daily by the ISD supervisor to
allow for weekly monitoring of ISD referrals by
grades and to also identify students who required
excessive visits to ISD. Students receiving an ISD
were not referred to the office.
Theoretically, ISD was designed to serve
several distinct functions. First, from an instructional
perspective, after reasonable attempts by teachers
have failed to gain student cooperation, the ISD
strategy offered staff an option to continue teaching
the remainder of students in the classroom and
maintaining acceptable levels of student engagement.
This strategy also incorporated a brief teaching
strategy (i.e., problem-solving activity) that allowed
the student to review established behavioral
expectations and to also process the circumstances
surrounding the problem behavior. An additional
function, from a behavioral perspective, it that it
removed the student from the classroom environment
where he or she often received continued social
attention from both peers and adults, which is often
found to result in serving as a maintaining
consequence that promotes continued display of the
problem behavior (O'Neill et al., 1997).
Wednesday Detention
Wednesday Detention served as a more
intensive consequence strategy employed for students
receiving excessive ISD referrals (i.e., greater than 2
per week), minor infractions (e.g., repeated dress
code violations), and/or for students receiving written
infraction for non-threatening major behavioral
infractions (e.g., continued disruption, defiance). The
consequence strategy was designed to provide
students with supplemental instruction that was
directly related to his or her problem behavior(s)
during after school hours on Wednesday afternoon,
which was an early dismissal day for all students.
During a visit to Wednesday Detention, students
were required to remain after school for two hours to


complete a series of written skill specific behavioral
or social skill activities using the Advantage Press
curriculum (2000). In addition, students failing to
complete academic assignments as the result of their
misconduct were required to complete assignments
during Wednesday Detention. Students receiving
repeated Wednesday Detentions (i.e. greater than 3
during a semester) were referred to the buildings
Teacher Support Team to determine whether
additional supports and interventions were necessary.
In School Suspension
As an alternative to out of school suspension
(OSS), school personnel were encouraged to use In
School Suspension (ISS) as a consequence strategy
employed for students who demonstrated repeated
minor offenses (e.g.,, repeated Wednesday
Detentions) and/or for youth who committed major
behavioral infractions (i.e., harassment, intimidation,
fighting/assault) that would have otherwise resulted
in an OSS consequence using the traditional
discipline ladder from the previous year. Typical ISS
visits ranged from 1-3 days with some students being
referred for up to 10 days for significant threatening
infractions (e.g., repeated fighting/assault). Unlike
traditional ISS programs that often isolate students to
independently perform academic-related tasks, the
ISS program employed in this model was somewhat
different. First, the district's ISS program was located
on a different campus from their home school at the
district's alternative school. Parents of referred
students were required to check their students in and
out each day when attending ISS. This helped to
ensure that parental involvement in the management
of student problem behavior was maximized to the
extent possible as staff often met with parents at the
end of each day to discuss student behavior. When
attending ISS students were required to complete
academic skill activities that are appropriate for their
instructional level for approximately one-half of the
school day. In an attempt to prevent promoting a
pattern of escape or avoidance-maintained behavior
patterns, students were required to make up all
missed class assignments prior to the next
Wednesday Detention. In cases when a student failed
to satisfactorily complete assignments missed as the
result of attending ISS, he or she was required to
complete these assignments during subsequent
Wednesday Detention sessionss. In addition to
completing instructionally appropriate academic
exercises during ISS, referred students were required
to complete a series of written behavioral and/or
social skills activities that directly addressed their
referral concerns developed from the Advantage
Press (2000) curriculum. Students who were referred
to ISS were also referred to the school's Teacher


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Support Team to begin the process of developing and
implementing an individualized behavior support
program. Although discouraged by district personnel,
students who were repeatedly sent to ISS could also
be assigned out of school suspension (OSS) if staff
deemed this consequence as necessary. However, the
goal of the revised disciplinary system was to keep
students in school. Therefore, school personnel were
encouraged by district administration to implement
preventative contingent reinforcement strategies as
part of the individualized behavior support plan and
minimize the use of OSS. If the student continued to
display a pattern of disruptive behavior, then school
personnel were instructed to refer the student to the
in-school alternative program in addition to the
implementation of the behavior support plan.
In School Alternative Program
Students in grades 3-12 who presented with
chronic patterns of repeated misconduct and have
failed to benefit from previous and less intensive
consequence strategies (i.e. three or more ISS visits)
were referred to the school's on-site alternative
program located at their home school for a 45 day
period. Once a student was referred to the school's
on-site alternative program, a functional behavior
assessment was performed for the purpose of
developing a comprehensive behavioral support
program. The FBA identified antecedent events
triggering the problem behavior and consequent
events maintaining the problem behavior while the
comprehensive positive behavior support plan
identified predictor, teaching, and consequent
strategies needed to teach appropriate replacement
behaviors and reduce the occurrence of problem
behavior (O'Neill et al., 1997). Students attending
the on-site alternative program were provided with
instruction on core curriculum objectives delivered
by a certified teacher. Students also participated in
daily character education groups conducted by the
school counselor and/or positive behavior support
specialist. Additional wrap-around supports were
coordinated with external agencies as needed (i.e.,
regional mental health, psychiatric follow up).
Transitioning Students
As mentioned previously, all students
attending the on-site alternative program were
provided with a comprehensive, function-based
behavior support plan that included specific strategies
and accommodations designed to increase pro-social
patterns of behavior. As such, specific replacement
behaviors were identified and rated for each student
at the end each class period utilizing a behavior
tracking form to provide students with on-going and
regular feedback regarding their behavioral progress.


The behavior tracking forms were also used to
monitor overall behavioral progress for each student
in order to make important and informed decisions
regarding their ability to transition back into less
restrictive environments. In an attempt to incorporate
each student's behavioral support program into the
regular classroom setting and to reinforce pro-social
behavior patterns, students attending the on-site
alternative program were allowed to earn back each
of their regular education classes one at a time
contingent upon the demonstration of improved
conduct. That is, once a student demonstrated an
acceptable level of behavioral conduct (i.e., an
established criterion) and reached and maintained
their individual behavioral goals across a two week
period, he or she was allowed to begin transitioning
back to the regular school setting at a rate of one
class per week. Once fully transitioned, each
student's behavioral support plan continued to be
fully implemented and monitored weekly by the
school's behavioral support specialist. Behavioral
support programs were then faded when appropriate
or continued when needed.
Alternative School Program
The school district's alternative school was
the most intensive consequence strategy designed to
address the needs of students in grades 5-12
(approximately 1% of district's population) who
demonstrated continued chronic misconduct, as well
as, students who committed significant violations
related to explicit threats toward adults, severe
assault, possession of a weapon, or possession of
illegal drugs. Students referred for placement in the
district's alternative school had to undergo a due
process hearing and were placed in this setting for a
full calendar year only after the approval of the Board
of Trustees.
In contrast to the typical punitive model
endorsed by traditional alternative school models, the
overall mission of the district's alternative school
here is proactive, therapeutic, and instructional in
nature. With this in mind, once placed in the off-
campus alternative setting, each student, along with
parents, participated in a school-wide orientation
where school expectations, procedures, and policies
were reviewed. Instructionally, each student was
provided with daily instruction based on his or her
regular core education curriculum, including
numerous electives with a teacher to pupil ratio that
never exceeded a 1:15 ratio. Students with disabilities
were provided with inclusion supports as needed.
Students who met the conduct and academic
requirements were also given the privilege of


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participating in other extra-curricular activities (e.g.,
sports).
To address the behavioral, social, and
emotional needs of students attending the alternative
school, a full time licensed social worker and a part-
time licensed school psychologist were employed to
assist staff and to provide ongoing intervention with
students. Each student's overall behavior related to
his or her demonstration of school-wide behavioral
expectations was
rated weekly by Figure 2. Number of Suspension Days.
the teaching 2000
staff. The
weekly ratings 18
were
incorporated
into a school- 1400
wide monitoring
system that was i 1200
used to
1000
determine
whether students 8
earned the
privilege of 00
attending his or
her home school 400
the next school
term. Consistent 200
with other
school buildings YearpnortoPBIS Ye. 1
in the district,
the alternative school also incorporated both class-
wide and school-wide positive incentive programs to
promote pro-social behavior patterns.
In terms of consequence strategies, students
enrolled in the district's alternative school were
referred to the local youth court for either informal or
formal follow-up. Students who had a chronic pattern
of significant misconduct and were deemed to be in
need of strict supervision were enrolled in a youth-
court program (Adolescent Offender Program) which
provided additional therapeutic and wrap around
supports as needed.
Outcomes for the PBIS Program
In addition to changing staff philosophy
with regard to student discipline and providing more
proactive strategies for addressing student display of
problem behavior, school administrators wanted to
revise the traditional school discipline ladder in order
to keep students in school to effectively meet their
behavioral and academic needs. In particular, district
administration hoped to reduce the number of ISS
and OSS infractions for the student population.
Analyzing different types of office referrals have


255


been shown to be effective in evaluating PBIS
strategies (Bohanon et al., 2006; Ervin et al., 2007;
Irvin et al., 2006; Nakasato, 2000; Scott, 2001;
Walker et al., 2005). For example, discipline
referrals have been found to be sensitive measures of
school climate as well as valid indicators of
intervention effectiveness (Irvin, Tobin, Sprague,
Sugai, & Vincent, 2004).
Students who display chronic behavioral problems
account for approximately 50% of the incidents
handled by
administrative
personnel and such
problem behaviors
often consume up to
80% of instructional
time (Lewis-Palmer &
Barrett, 2007; Sugai &
* I Homer, 1994). As
3 oss such, data will be
presented for two
commonly used
disciplinary
procedures used in the
traditional model to
provide support for the
reconceptualization of
the disciplinary ladder
using a PBIS
Ye2r ofPBS approach. Figure 2
presents ISS and OSS
data for the year prior
to the implementation of PBIS and for 2 years of
PBIS implementation for the entire district.
Results from this school-wide PBIS effort
revealed that the number of ISS days reduced from
1774 the year prior to PBIS implementation to 381
days during the second year of implementation. This
represents a mean reduction of 9.6 days of ISS
assigned per day in the year prior to PBIS to a mean
reduction of 2 ISS days assigned per day during the
2nd year of PBIS. Although staff were discouraged
to use OSS as a punitive consequence for the display
of problem behavior, these data were still tracked in
an effort to evaluate if students were remaining in the
educational environment as a result of the
modification to the traditional discipline systems.
Evaluation of these data revealed that OSS days
reduced from 384 the year prior to PBIS to 123
during the second year of the program. This
represents a mean reduction of 2.1 days of OSS
assigned per day to .7 days of OSS assigned per day
after two years of implementation of PBIS.
Unfortunately, many students who engage in aberrant
and anti-social behavior at school are labeled as


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"unmanageable" leading to removal from the school
environment and placement in juvenile detention
facilities or residential treatment centers (Lewis, et
al., 1998; McCurdy, et al., 2003). The model adopted
by this school district sought to keep students in
school while providing them with the wrap-around
services needed to address their needs. Thus, the
reduction in OSS days is socially relevant from the
perspective that students were maintained in
supportive environments designed to foster academic
and behavioral skill development (Sugai & Homer,
2006). Other data that support the addition of PBIS
strategies to the overall district health and wellness
project were reported by Kolbo and Beardshall
(2006). For example, an average of 11% of students
dropped out per year during the two years that PBIS
strategies were added to the larger health and
wellness project. However, an average of 31% of the
students dropped out per year in the three years prior
the addition of positive behavior supports to the
larger project.
Issues and Considerations: Lessons Learned
Specific lessons learned from the
implementation of PBIS strategies have been
effectively discussed in the literature (Chapman &
Hofweber, 2000; Colvin & Fernandez, 2000;
Lohrmann-O'Rourke et al., 2000; Nakasato, 2000;
Nersesian et al., 2000; Netzel & Eber, 2003; Warren
et al., 2003). However, we will reiterate some of
these "lessons learned" from this experience in
implementing PBIS strategies in a rural public school
district. First, administrative support is absolutely
critical to properly implement PBIS in a school
district. Changes to current practices need to be
fostered and modeled by administration for staff to
truly "buy-in" to the change in philosophy from using
reactive and punitive strategies to more proactive,
remedial strategies. Implementation of PBIS requires
different budgetary changes and modifications to
current policies and procedures including revision to
student handbooks. As such, district superintendents
and school boards must support the efforts in order
for the process to proceed to actual implementation.
Second, team-based decision making at all levels of
the model must occur. Staff must take ownership of
the model and develop continued self-evaluation
strategies for improvement in implementation of the
model. This often involves ongoing training for
correct implementation of practices as well as
evaluation techniques for judging the effectiveness of
the revised practices. Third, data must drive
important decisions. The collection of data informs
the staff of which systems are working within the
model and which systems need modification. Thus,
the modification to school-wide, classroom, specific


setting, and individual student systems must be
supported by data-driven outcomes. If not,
premature and inappropriate decisions may be made
with regard to student needs and systemic changes.
Fourth, a long-term commitment from all
stakeholders must be secured in order for the PBIS
efforts to be sustained. Changes in philosophy can be
hard and full implementation can take anywhere from
3-5 years (Chapman & Hofweber, 2000). If schools
do not make an effort to sustain the gains and
continue the implementation of the procedures with
proper integrity, then PBIS could become the next
"educational fad" for the school district. Given the
aforementioned issues, the authors recommend that
the PBIS effort become part of the school's mission
and continued plan of improvement in order to secure
the support needed to maintain ongoing efforts.
PBIS provides school personnel with an
empirically-based method to address student problem
behavior proactively in order to move beyond the
traditional system of viewing student misconduct as a
criminal act that must be punished using an outdated
and often ineffective model of discipline. In
relation, Mayer and Sulzer-Azaroff (1991) have
reported that punishing students who display problem
behavior without the incorporation of school-wide
positive behavior support strategies is typically
associated with increases in negative behaviors
including aggression, vandalism, truancy, tardiness,
and school dropouts. Therefore, PBIS strategies are
effective because they focus on system change
procedures that are designed to not only improve the
quality of life for the students but improve the
atmosphere of the educational setting by allowing
school personnel to work Silnliii" instead of
working harder (Lewis-Palmer & Barrett, 2007).

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SCHOOL-WIDE SYSTEMS OF POSITIVE BEHAVIOR SUPPORT: A FRAMEWORK FOR
REDUCING SCHOOL CRIME AND VIOLENCE
Terrance M. Scott, University of Louisville, Joseph Calvin Gagnon, Ph.D., University of Florida, & C. Michael
Nelson, University of Louisville

School-wide positive behavior support (SWPBS) currently is implemented in over 7,000 elementary, middle, and high schools
throughout the United States. Among the beneficial outcomes reported by these schools are dramatic reductions in office
discipline referral rates, increased instructional time for students formerly removed for disciplinary reasons, and improved
academic performance (including gains in academic year achievement test scores). While additional research concerning the
effects of specific SWPBS components (especially outcomes of secondary and tertiary prevention efforts) and mediating factors
is needed, there is a great deal of evidence that SWPBS is a significant part of a comprehensive and effective approach to school
safety (Sugai & Homer, 2005). In this article, we review conceptual and empirical foundations for the distinguishing
characteristics of PBS and discuss the application of each of these characteristics as a means to enhance school safety.


Over the past decade, juvenile arrests have
declined for many serious offenses including violent
crime, property crime, vandalism, and weapons
(Snyder & Sickmund, 2006). The most recent data
concerning juvenile victimization indicate
There are also downward trends in incidence
of violent crime or theft at school (Centers for
Disease Control and Prevention (CDCP), 2004;
DeVoe, Peter, Noonan, Snyder, & Baum 2005;
Dinkes, Cataldi, Kena, & Baum, 2006; Snyder &
Sickmund). The odds of a youth in a U.S. elementary
or secondary school being a victim of a school-
associated violent death are more than 1 in 3,000,000
(DeVoe, Peter, Noonan, Snyder, & Baum).
Additionally, over a 10-year period, the number of
high school youth that reported they had been in a
physical fight over a 12 months period fell from 43%
to 33% (CDCP, 2004). CDCP noted that only 4.2%
of youth were injured and treated by a doctor or
nurse. Moreover, only 13% of high school students
reported being in a physical fight on school property,
also a decline over 10 years.
However, violence and theft continue to be
significant problems in American schools. For
example, consistent with the previous 10 years, 9%
of high school youth reported being threatened with a
weapon at school and 29.8% of youth reported
property stolen or damaged at school (CDCP, 2004).
Clearly, even low rates of violent, non-compliant,
and disruptive behavior in school produces a concern
with school safety and the use of such means as metal
detectors, school safety officers, and video
surveillance have increased dramatically--despite
evidence that such measures have had little effect on
incidents of serious offenses (Mayer & Leone, 1999).
In fact, although there is evidence that metal
detectors may reduce the number of weapons in
schools, students experience the same frequency


threats and fighting in schools with metal detectors as
they do in schools without (Ginsberg & Loffredo,
1993). Schneider, Walker, and Sprague (2000, p. 18)
assert that reliance on security measures is "fraught
with limitations, and it may be appropriate only
within chaotic schools that serve crime-ridden
neighborhoods." Although the concerns of parents
and school personnel about the safety of their schools
are warranted, evidence continues to suggest that
prevention through strategies that promote pro-social
student behavior (i.e., the development of
environments that predict success and an
instructional approach to discipline) provides the
most effective means to improve school safety.
Multi-Tiered Prevention
A distinguishing feature of multi-tiered
systems is the focus on prevention as an underlying
premise and focus of both interaction and structure
(Lane, Gresham, & O'Shaughnessy, 2002).
Prevention is a well-established concept that
describes the thwarting of a predictable outcome. We
can say we have engaged in prevention efforts when
we identify an undesirable outcome and change both
interactions and structures in an attempt to avoid
such. From a practical standpoint we can strive to
prevent only what we can predict and this makes
evaluation quite difficult, as we cannot measure what
has not happened and can only compare current
outcomes to historical data. Still, prevention can be
inferred from large scale implementation, as has been
demonstrated with the reduction in polio with the
advent of the Salk vaccine (Francis Jr. et al., 1955)
and decreases in reading disabilities in children of
poverty through the use of effective instruction
(Gersten, Becker, & Heiry, 1984; Gersten, Darch, &
Gleason, 1988).
According to Webster-Stratton (1997),
approximately 15% of preschool students exhibit


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challenging behaviors that place them at risk for
emotional behavior disorders (EBD) in the future.
Moreover, Campbell (1994) suggested that preschool
students who display challenging behaviors are 50%
more likely than their peers to continue with problem
behaviors in their academic careers. Children who
demonstrate problem behavior in preschool and do
not receive preventative services are especially likely
to exhibit challenging behavior patterns as they grow
older (Patterson, DeBaryshe, & Ramsey, 1989;
Walker, Colvin, & Ramsey, 1995). Although half of
the young students entering kindergarten demonstrate
aberrant behavior, evidence suggests that the
implementation of a supportive environment and
proactive approaches is successful in preventing
problem behaviors in most students (Conroy et al.,
2002; Morin, 2001). However, not all people who
failed in school demonstrated problems as early as
kindergarten; some had their first behavioral failures
as late as high school. Thus, prevention cannot be a
concept that is confined to early childhood. In a
multi-tiered prevention framework, prevention at the
individual student level must be considered at the
first signs of failure. Evidence is clear that the longer
a student is allowed to fail, the likelihood of affecting


Figure 1: The Three Tiered Model of Prevention







3-5% of population -
Students with Inte
Needs

10-15% of
-opulation:
students at
sk of
L rer


meaningful and lasting change is lessened (Scott,
Nelson, Liaupsin, Jolivette, Christle, & Riney, 2002).
Prevention cannot be provided in the sense of a
simple inoculation or "booster shot" for children
prone to failure (Hart & Risley, 1995). Rather,
prevention must be considered and delivered in
multiple contexts and across multiple levels within
the school.
Multi-tiered systems of prevention have
been widely advocated (Carr et al., 2002; Mayer,
Butterworth, & Nafpaktitis, & Sulzer-Azaroff, 1993;
Nelson, Martella, & Marchand-Martella, 2002; Sugai
& Homer, 1999; Walker & Shinn, 2002) and
demonstrated as an effective process for facilitating
success in both the behavior (e.g., Luiselli, Putman,
& Sunderland, 2002; Nakasato, 2000; Nersesian,
Todd, Lehmann, & Watson, 2000; Scott, 2001) and
academic (RTI, see Fuchs, Mock, Morgan, & Young,
2003) realms. These efforts typically begin at the
school-wide level and involve all school personnel
and parents in the process of assessment, planning,
intervention, and evaluation.
This three-tiered model is built on a systems
approach to preventing failure and borrows heavily
from a variety of perspectives, including mental
health, medicine, and business. Common features of
this model include (a) a proactive focus on
prevention of predictable problems and failures; (b)
collaboration among all in the system - including all
school personnel, family, and community services as
appropriate; (c) research-based practices to insure the
greatest likelihood of success; (d) effective
instruction of key skills; (e) encouragement and
acknowledgement of positive behavior; (f) consistent
application and enforcement of expectations across
time, adults, and students; and (g) formative
evaluation and data-based decision making National
Research Council & Institute of Medicine, 1999,
2000; (Scott & Eber, 2003; Turnbull, Friesen, &
Ramirez, 1998; Zins & Ponti, 1990).
Existing research has shown that effective
prevention effort, such as the multi-tiered model, is
associated with a decrease in disruptive student
behaviors and the resulting exclusionary disciplinary
practices (i.e., suspension and expulsion) (Metzler,
Biglan, & Rusby, 2001; Nelson, Martella, & Galand,
1998; Scott, 2001; Taylor-Greene, & Kartub, 2000).
A review of this research highlights three features of
effective school-wide systemic approaches to
preventing disruptive or dangerous behavior. First,
persons in the system (i.e., stakeholders) agree on the
need for change and the strategy (Kling, 1997; Scott
& Hunter, 2001; Wesley, Buysse, & Keyes, 2000).
As Garmston and Wellman (1999) have suggested,


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systems-change occurs only when those in the system
share dissatisfaction with the current state, a vision of
the desired state, and knowledge of the steps to
getting there; and see these as being greater than the
cost, real or perceived, of change (see Scott, Nelson,
& Zabala, 2003). Systemic models of prevention
must be implemented with sufficient fidelity across
persons, times, and locations to create consistent and
predictable expectations and routines (Colvin,
Kame'enui, & Sugai, 1993; Scott & Hunter, 2001;
Nelson, Martella, & Marchand-Martella, 2002).
School-Wide Positive Behavior Support
One of the most widely researched and
supported multi-tiered approaches to prevention and
promoting school safety is School-wide positive
behavior support (SWPBS). SWPBS generally refers
to the prevention of student behavior problems via
the development of positive environmental actions
and structures. Carr et al., (2002) have described
positive behavior support as an evolution of the
science of applied behavior analysis, focusing on
socially valid behavior change in applied settings.
The evolution of SWPBS has widened the scope of
social validity to focus not just on the individual but
the larger environment in considering the
effectiveness, efficiency, and acceptability of an
intervention (Sugai et al., 2000). In this sense,
intervention becomes the purview of the school rather
than specialists and SWPBS generally refers to
school-based efforts at preventing student failure
through effective instruction and the purposeful
arrangement of environments.
The triangle in Figure 1 presents what is
typically predictable for student success. The bottom
tier of the triangle represents the approximately 80%
of students who succeed when primary prevention
strategies are in place (e.g., a consistent environment,
clear expectations, and positive adult attention).
However, regardless of how effectively primary
prevention processes are implemented at the school-
wide level, 10-15% of students are not successful and
therefore are at-risk (the second tier of the triangle).
Thus, at-risk students are identified by their failure to
respond to primary prevention. These students will
require secondary prevention, which consists of more
intensive systems-level interventions that are applied
to smaller groups of students (Blair, Umbreit, & Bos,
1999; Drasgow, Yell, & Bradley, 1999; Eber, Smith,
Sugai, & Scott, 2002). The significance of primary
prevention is two-fold: first, school staff are not
distracted by frequent minor behavioral infractions
that occupy a great deal of time, and second, when
effective universal practices are in place, the number
of students who fall into this at-risk group is much


lower (Sugai, Sprague, Homer, & Walker, 2000).
This means that staff can more readily identify at-risk
students and provide interventions that are more
suited to their needs.
However, even this second level of
prevention will not be sufficient for a small portion of
students (the 3-5%represented by the upper tier of the
triangle). These students are candidates for tertiary
prevention systems that involve the most intensive
procedures, which must be: (a) collaboratively
planned, (b) based on functional behavior
assessment, and (c) implemented across the school
with input from the student, family, community
agencies, and peers (Eber, 1996; Kennedy, Long,
Jolivette, Cox, Tang, & Thompson, 2001; Waddell,
Wong, Hua, and Godderis, 2004). This small group
of students accounts for the majority of a school's
behavior referrals and disciplinary actions (Sugai,
Sprague, Homer, & Walker, 2000). The logic then is
clear: as schools do a better job of ensuring success at
the school-wide primary prevention level and
detecting as well as responding to student behavior
failures early through secondary prevention, there
will be fewer students with intense behavior
problems and fewer extreme and disruptive behaviors
that negatively affect school safety. Furthermore, by
using school-wide discipline data (e.g., office
disciplinary referrals) to identify students who
require more intensive levels of intervention, staff
can more quickly and efficiently allocate limited
resources to address their needs.
Four characteristics distinguish SWPBS.
First, SWPBS is a form of value-based systemic
change involving all who work within or have a
vested interest in the school (Carr et al., 2002; Sugai
& Homer, 2002). In this sense, stakeholders are
integral to the planning, implementation, and
evaluation processes (Tumbull, Friesen & Ramirez,
1998; Zins & Ponti, 1990). Second, all SWPBS
intervention strategies are founded on the concept
and practice of effective instruction (Colvin,
Kameenui, & Sugai, 1993; Sugai et al., 2000).
Teaching and learning are viewed as a science and
the process as a hallmark of any effective
intervention (Brophy, 1986). Third, SWPBS is based
on the concept of prevention (Sugai & Homer, 2002).
Efforts to predict behavior are used to create
instruction and environments that effectively prevent
failure (Sugai et al., 2000). Fourth, SWPBS involves
formative assessment of measurable outcomes and
data-based decision making (Carr et al., 2002;
Colvin, Kameenui, & Sugai, 1993; Sugai et al.,
2000). Assessment and evaluation not only address
the effects of interventions, but also the larger and
more socially valid questions concerning "lifestyle"


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change (Clarke, Worcester, Dunlap, Murray, &
Bradley-Klug, 2002). In the following sections, we
address each of these characteristics separately.


Systemic Approach
The systemic approach is a core concept of
SWPBS systems. SWPBS provides a framework for
the development of effective systems in which
structures are altered or developed by the system
rather than imposed by administrative fiat (Lewis &
Sugai, 1999; Sugai et al., 2000). A basic assumption
of SWPBS is that failures among individuals in the
system occur as a result of deficient environments.
As Carr et al. (2002, p. 8) state, efforts are, "on fixing
problem context, not problem behaviors." In this
sense, the context is the environment and includes all
persons, their behaviors, the curriculum, how the
curriculum is delivered, and the structure of rules,
routines and physical arrangements. Simply put,
SWPBS is a systemic process of developing school
environments for the purpose of positively affecting
the outcomes that are important to the system. This is
sometimes more colloquially stated as, "adult
behavior change must precede student behavior
change." A focus on adult behavior may seem
counterintuitive. However, this approach simply
acknowledges that if we want a student to engage in
an appropriate behavior, adults also must exhibit
appropriate behavior: providing instruction (e.g.,
teach rules), altering the environment via use of
prompts, consistent routines, and providing feedback
to make that desired student behavior more likely.
One of the distinguishing features of a
systemic implementation of PBS is the involvement
of all stakeholders (teachers, staff, specialists,
administration, parents, and students) in decision-
making, implementation, and monitoring (Mayer,
Butterworth, Nafpaktitis, & Sulzer-Azaroff, 1993;
Sugai et al., 2000). Such an approach recognizes that
there are multiple interactions within a system (e.g.,
communication styles, feedback, directives), that
these interactions are influenced by structures (i.e.,
rules, routines, and physical arrangements), and that
these interactions impact one another and, ultimately,
the entire system. For example, a school can be
defined as a system. The effect of the interactions
within that school (e.g., collaboration, instruction,
employee morale, leadership styles) are determined
by how they are facilitated by the existing structures
and together, interactions and structure will impact
whether and how well the school meets its goals for
promoting student learning and making adequate
yearly progress (AYP). In this sense the culture of the
school (i.e., the context in which things take place


and the value given to outcomes in the system) plays
a large role in its success. A systemic approach is
needed when the goal of the system is to affect
change that benefits and perpetuate the entire system.
For example, interactions between teachers, teachers
and administrators, and teachers and students may
inadequately promote student punctuality, leading to
a loss of instructional time and ultimately lead to not
achieving AYP.
A systemic approach, however, is more than
simply adding structures to affect change in a system.
Strahan (2005) observed that school-wide reforms
were successful in schools where reform agendas
were developed by a range of insiders who were
invested in the change. In contrast, prevailing
evidence suggests that top-down imposition of such
structures often impact the interactions of
stakeholders but create little lasting change to the
overall system (McLeskey & Waldron, 2000).
Rather, Fullan (1993, 2001, 2005) argues that
systemic change must involve both the structures and
culture of a system. In other words, the capacity to
effectively alter interactions within a system must be
built within the system. Efforts to effectively alter a
system should focus on addressing the local context,
establishing effective leadership, and promoting
collaboration among stakeholders in pursuit of a
common goal.
Systemic change and school culture. Schools
differ in many respects, such as, teacher, student, and
community demographics, as well as values and
beliefs. Each school has its own unique attributes
including adults, students, values, ethnic makeup,
size, and age of students. These differences, and
more, contribute to the culture of a school. Thus,
redefined for the school, culture is the context in
which everything in the school takes place; it is the
way things are done and the behaviors and outcomes
that are valued. Because school culture is specific to
the school, there can be no universal school
structures. That is, what may be an appropriate rule
for one school may be quite inappropriate for
another. An obvious example of culture can be seen
in considering elementary and high schools. Rules
that are necessary for early elementary students (e.g,
ask before getting a drink) may be wholly
inappropriate for seniors in high school. Thus, the
entire system must be involved in determining the
specific rules and environmental structures that are
appropriate and agreeable in relation to their values.
The question that is asked as part of considering
school culture in systemic change is, "what behaviors
do successful people in our culture (age, economic
status, neighborhood, ethnicity, creed, etc.) possess
and how can we facilitate those behaviors in our


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students?" This is a question that must be answered
by the stakeholders in the system and often requires
both collaboration and compromise.
For example, stakeholders at City High
School determined that on-time arrival to class was a
valued behavior but that being tardy was a frequent
student misbehavior. Their interaction generated
agreement on the values and identification of
problems but change in structure is still needed to
change behavior. One half of the stakeholders
suggested that students must be at their desk with
their pencil in their hand when the bell rings. The
remainder of the stakeholders were much less
concerned and suggested that students need only to
be in the classroom within a "reasonable" time after
the bell. Neither side was at all willing to accept the
other's position but, after a long discussion, they
were able to agree on a compromise rule: students
were to be over the threshold of the doorway when at
the bell. This was the first choice of neither side but
was a rule to which all could agree. Only through a
system-wide interaction were they able to define the
structures to create success.
Systemic change and effective leadership.
Research supports the contention that strong
leadership is necessary for successful initiation and
maintenance of systemic change in schools. A
correlational study by Kelley, Thorton, & Daugherty
(2005), indicated that school climate is directly
related to teachers' perceptions of their principal's
effectiveness as a leader. Strong leaders serve as a
guiding force in directing change and provide support
for faculty and staff. Similar studies have concluded
that staff consistently emphasize the principal's role
in building shared leadership and a professional
culture (Lambert, 2005) and that principals influence
teacher commitment to teaching, school, and students
(Sun, 2004). What this means for PBS is that the
capacity for a school to initiate and maintain
important and effective change in the environment is
seriously undermined if it does not have quality
leadership. Sugai and Homer (1999) stated that, "one
of the most important elements in the development
and implementation of a proactive systems approach
to behavior support is administrative leadership" (p.
17). Although there currently exists no direct
research on the importance of leadership on the
success of PBS in schools, the systemic change
process relies on the administrator's ability to
organize, facilitate, encourage, and enforce school-
wide decisions and commitments to change.
Systemic change and collaboration. Tied
into the concept of school-wide change is the concept
of collaboration. Through collaboration teachers


create mutual understanding, which is necessary for
school-wide programs to succeed. Marris (1975)
cautions that innovations cannot be assimilated
unless their meanings are shared, and shared
meanings emerge through collaboration to create a
sense of ownership. Many studies have examined
collaboration in school settings and have found that
continuing conversations with colleagues helped
them understand and incorporate new ideas into their
current practices (Spillane, 1999; Cobum, 2001;
Strahan, 2003). In PBS, collaboration begins with the
agreement that change is necessary and continues
through consensus on specific changes (Lewis &
Sugai, 1993). Lewis and Sugai suggest that schools
conduct a needs assessment via a team that is
representative of all segments of the staff and faculty.
Once the team has assessed the school needs, they
then move onto developing an action plan. Although
collaboration is a key element in PBS, there are no
studies that have specifically removed the
collaborative element from the framework to judge
its importance to the PBS process.
Systemic change and coherence. The
concept of coherence is closely related to and
influenced by leadership. Fullan (2001) refers to
program coherence as "the extent to which the
school's programs for student and staff learning are
coordinated, focused on clear learning goals, and
sustained over a period of time" (p.146). Similarly,
Danielson (2002) characterizes it as 1ho" schools
arrange the resources of time, space, and personnel
for maximum effect on student learning" (p. 43). The
two major elements of program coherence are
organization and consistency. When programs have
coherence, systemic activities are organized around
clearly identified and agreed upon objectives. Staff
member's training and efforts are central to
achieving these goals. All in the system are aware of
the objectives, committed to them, and work
consistently to achieve them. Student achievement is
increased when schools have both a strong program
coherence, (Kiger, 2002; Newman, Smith,
Allensworth, Byrk, 200 la) and staff members with a
strong commitment to achieving school-wide
objectives (Nci\ Iman Smith, Allensworth, Byrk,
2001b). In a system of school-wide PBS organization
is achieved when stakeholders reach collaborative
consensus on the school-wide structures to be
implemented in the school. Consistency is achieved
when stakeholders make a commitment to abide by
and enforce these school-wide structures for the
course of the entire school year (Sugai & Homer,
1999). As a result of this organization and
consistency, students become aware of the rules and a
sense of expectancy and predictability is established.


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Systemic change and safe schools. Overall,
it appears that each component of the systemic
approach is supported to some extent by research.
However, systematic research examining the
importance of the components specifically related to
improving school safety appears to be lacking.
Several systemic components of PBS are represented
in the Bullying Prevention Program. The Bullying
Prevention Program includes school, classroom, and
individual interventions provided in comprehensive,
collaborative, and coherent manner. The focus on
maintaining effective and consistent school systems
aimed at a reduction in bullying has resulted in a
reduction theft, vandalism, and truancy as well
(Olweus, 1991). Moreover, in their review of
research, Wilson and Lipsey (2005) reported the
important effects of appropriate implementation of
interventions on prevention of student violence.
Having a school-wide system in place that ensures
fidelity of implementation by all staff is clearly a
significant consideration for promoting safe schools.
The fact that key systemic approaches improved
school safety and are aligned with SWPBS is
important support for the use of the latter to promote
school safety.
Effective Instruction
A second distinguishing feature of systems
of PBS is use of effective instructional practices - the
development and delivery of content and learning
environments to teach important rules, routines, and
physical arrangements to both adults and students.
With the reauthorization of the Individuals with
Disabilities Education Act of 1997 (IDEA), educators
are mandated to implement positive behavioral
support (PBS) strategies with students who
demonstrate behavior problems that hinder the
learning process (Tumbull, Wilcox, Stowe, &
Tumbull, 2001). In response to this mandate, schools
are implementing PBS at school wide levels, and
recognizing that social behaviors need to be taught in
the same manner in which academic skills are taught
(Homer & Sugai, 2000). In order for schools to
become safe environments in which all students can
learn, appropriate behaviors must be taught not just to
students exhibiting behavior problems, but to all
students. In the same manner in which Adams (1990)
promotes the prevention of reading difficulties in
children through early intervention and explicit
instruction, PBS advocates prevention of behavior
problems through instruction of behavioral
expectations and social skills.
Because students with behavior problems
often suffer from learning problems that can be
linked to the instructional environment (Becker &


Carine, 1980; Gunter & Denny, 1998; Gunter,
Hummel, & Conroy, 1998; Kameenui & Darch,
1995), Kauffman (2 1114) has identified effective
instruction as a decisive component of any
intervention for student behavior. Too often, teachers
of students with learning and behavior problems
focus their efforts on managing problem behaviors
rather than engaging in meaningful and effective
instruction (Gottfredson & Gottfredson, 2001; Jack et
al., 1996; Shores et al., 1993; Wehby, 2003; Wehby,
Symons, & Shores, 1995; Wehby, Tally, & Falk,
2004). Within a system of PBS it is stressed that
teaching academic and social behaviors are equally
important, learned, and must be taught using the
same effective methods.
Design of effective instruction. Effective
instruction of any behavior involves: (a) review; (b) a
meaningful rationale; (c) presentation of information
via explicit instruction; (d) a range of positive
relevant examples juxtaposed with minimally
different non-examples; (e) opportunities to practice
with feedback; (f) non-trained examples that promote
generalization; and (g) review (Becker & Carine,
1980, Nelson, Johnson, & Marchand-Martella, 1996;
Rosenshine & Stevens, 1986). Student success can be
directly attributed to quality of instructional
arrangement, implementation, and maintenance over
time (Greenwood, 2002). Consideration of effective
instruction can be defined by the question ho\\ can I
teach this concept or skill in a manner so that I
maximize the probability of student success?" (Scott,
Nelson, & Liaupsin, 2001). Consideration of three
key instructional components is crucial to the
development of effective instructional practices.
First, skills and materials must match the student's
ability level and interests. Content that is either
irrelevant to the student or at a level that is too high
or too low will not be successful. Second, instruction
must be delivered in a manner that facilitates
understanding. Example selection and sequencing,
pacing, activities, and groupings are all important
delivery variables (Taylor, Pearson, Clark, and
Walpole, 2000). Third, as basic pedagogy prescribes,
students must receive immediate and consistent
feedback that is both evaluative and corrective as
necessary (Brophy & Good, 1986).
Effective instruction as a structure. To this
point, effective instruction has been described solely
as teacher and student interaction. However, learning
occurs in the context of a system or culture and,
therefore, the structures must be considered. Much of
the establishment effective learning environments is
completed before the student arrives as the teacher
considers timing, movement, transitioning,
proximity, setting arrangement and consequences.


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Clear and consistent expectations, routines, and
established schedules create a structure within which
success is maximized (Mayer, 1995; Taylor-Green et
al., 1997). Research has demonstrated that carefully
considered and structured learning environments are
associated with an increase in academic engagement
and success.
Effective instruction in relation to
reinforcement and punishment. Effective instruction
also involves feedback for both positive and negative
behaviors. Teaching of even the simplest skills is not
possible without some sort of feedback to help the
learner discriminate successful from unsuccessful
performance and to identify important features of a
complex skill or concept. If we are unable to tell
students whether a given answer is correct they will
never know, and if we do not tell them when an
answer is incorrect they may continue making that
error. As an instructional component, reinforcement
is simply feedback to acknowledge success (e.g.,
"Yes, you're right?"). Punishment is feedback to alert
the student to an incorrect response - generally
followed by re-teaching (e.g., "No not quite, let's
look at that one again and count your fingers this
time."). The purpose of reinforcement is to increase
the probability of positive behavior and the purpose
of punishment is to decrease the probability of
negative behavior. Reinforcement and punishment
are a part of SWPBS because they are an integral and
inseparable part of effective instruction. Research
indicates that acknowledgement of positive behavior
is a necessary but often missing component teaching.
Numerous researchers (Gunter, Denny, Jack, Shores,
& Nelson, 1993; Lago-Dello, 1998; Shores, Jack,
Gunter, Ellis, DeBriere, & Wehby, 1993; Skinner &
Belmont, 1993; Van Acker, Grant, & Henry, 1996)
have shown that students with challenging behaviors
tend to receive less acknowledgement for positive
behavior and more punishment for negative behavior
than their peers. The goal of PBS is to develop
systems that provide consistently effective feedback
for behaviors for purposes of creating predictable
success at the hands of the student.
Effective instruction and safe schools.
Within its literature base, PBS encourages the
teaching of behavioral expectations, skills instruction,
and social behaviors to all students (Homer & Sugai,
2000; Tumbull et al., 2001; Zuna & McDougall,
2004). Wilson and Lipsey (2005) conducted a review
of school-based violence prevention programs and
reported that social skills training and cognitive
interventions resulted moderate effect sizes.
Teaching appropriate behavior and
instruction of behavioral expectations are effective


approaches for promoting safe schools (Gottfredson
1997). Consistent with the tenets of PBS, validated
violence prevention programs such as The Incredible
Years Series (Campbell, 1990), Promoting
Alternative Thinking Strategies (Kusch6 &
Greenberg, 1994), and Life Skills Training (LST)
(Botvin, n.d.) promote social skills and social
competence through a combination of student, parent,
and teacher training.
Use of effective instructional approaches is
critical given that they may increase student
academic success (Taylor, Pressley, & Pearson,
2000). Academic failure is a predictor of behavior
problems and social failure (Maguin & Loeber, 1996;
Morrison & D'Incau, 1997; Reid et al., 2004).
Promoting safe schools should also take into account
the links between monitoring students, correct
responding, academic engagement, and finally
student behavior problems. Although there is clearly
a complex web of factors, it is possible to affect
change in the sequence. For example, the
recommended consistent monitoring of student
progress increases the likelihood that students will
respond correctly. As such, students will maintain
academic engagement (Landrum, Tankersley, &
Kauffman, 2003). Research (Greenwood, 1991;
Greenwood, Delquadri, & Hall, 1984) supports the
significant relationship between academic
engagement rates and student achievement. As noted,
student achievement can positively affect student
behavior and the safety of schools.
Structured learning environments
Data-Based Decision Making
The fourth distinguishing feature of a
systemic implementation of SWPBS is the formative
collection and use of data to make decisions. The key
decisions upon which effective intervention plans are
built exist in the answers to the questions: What
problems are predictable? How might problem
behavior be prevented school-wide? Which students
are exhibiting individual failure? What manner of
individual intervention is warranted? and what is the
measurable effect of intervention? (Scott, 2004;
Sugai, Sprague, Homer, & Walker, 2000). Data
collections is a critical component of both PBS and
effective behavioral management plans that promote
school safety (Gottfredson, 1997). Built on the
principles of effective instruction and applied
behavior analysis, SWPBS involves continuous effort
toward outcome goals that are deconstructed into
measurable instructional objectives. As with the
Individual Education Plans (IEPs) for students with
disabilities, monitoring of objectives provides both an
assessment of progress and prescribes the content and


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context of instruction in the immediate future. In a
system of SWPBS, data drives practice. Philosophies,
perceptions, and personal preferences among adults
are secondary to the effectiveness of a practice.
Therefore, evaluation in PBS is often discussed in
colloquial terms as, "if it works keep going, if it
doesn't - change."
Evidence for data-based decision making.
Business, government, and virtually every body of
science consult and use key data to direct their
actions. For example, physicians make decisions
based on an initial diagnosis and interventions by
reading physical data. When physical data improve,
the treatment is generally continued. But when
physical symptoms fail to improve, the course of
treatment is changed. Similarly, schools monitor the
behaviors and outcomes that they deem important.
Whether they assess academics, social behaviors, life
outcomes, or some combination is to be determined
by each school's stakeholders. General measures that
are consistent across schools include assessment of
the predictability of problem behavior and the effect
of school-wide prevention efforts. Formative
assessment of any data allows for the identification of
trends and thus predictability. Multiple examples
exist of schools using data to make decisions about
the structure and implementation of strategies aimed
at changing student behavior (see Lewis-Palmer,
Sugai, & Larson, 1999; Skiba, Peterson, & Williams,
1997; Sugai, Sprague, Homer, & Walker, 2000;
Tobin & Sugai, 1999).
As schools continuously assess behavior
(academic or social), trends and predictable contexts
become apparent. This information is then used to
direct intervention efforts and prevention in the
future. Whether those efforts continue will depend
upon whether the data demonstrate their effect in
changing behavior in some desired way. Evidence of
such a process in the school has been used to make
decisions regarding what, when, and where to
develop or alter prevention strategies in the school
(e.g., Nakasato, 2000; Nelson, Martella, & Galand,
1998; Taylor-Green & Kartub, 2000).
Data-based decision making for individual
students. Although the IEP has prescribed formative
assessment of progress for individual students,
assessment of individuals is more proactive in a
system of SWPBS. Whether from school-wide data,
teacher reports, or formal testing, schools must use
data to identify those students who are at risk of
failure rather than waiting for a formal diagnosis or
label (Wright & Dusek, 1998). Once student
problems have progressed to the point of formal
identification the chances of changing problem


behaviors have decreased dramatically (Loeber &
Farrington, 2000). As a general rule, schools should
attempt to identify the top 15-20% of those exhibiting
failure (Scott, 2004) so that early intervention
strategies may be employed. Without the use of data
to identify students early in a pattern of failure, small
problems will tend to grow and become both less
tolerable and less changeable (Mattison, Spitznagel,
& Felix, 1998). Despite appropriately implemented
intervention strategies, some of these students will
continue to display patterns of failure and will require
more intensive interventions. Individualized
assessment and data analysis is used at this level.
Whether the plan for monitoring the student be a
formal IEP, a 504 plan, or simply a measurable
instructional objective, the effectiveness of
intervention is objectively monitored so that
strategies may be evaluated (Sprague & Walker,
2000).
Data-based decisions in safe schools. Data
collection is at the heart of identifying effective
approaches to school safety (Gagnon & Leone,
2001). There is a consistent discrepancy between
public opinion and actual youth violence, with actual
violence being substantially lower (Furlong &
Morrison, 1994). As such, it is critical that data
collection methods and subsequent decisions move
beyond parental, administrator, and student
interviews. Additionally, data must drive the use or
disuse of interventions.
The future of data-based decision making is
first dependent upon the validity of the data that we
collect and the willingness of people to collect it. The
advent of more sensitive, efficient, or comprehensive
assessment surely will increase the use of data. For
example, there is great variation among indicators of
violence and indicators that due exist have several
limitations (Small & Tetrick, 2001). For example,
Small and Tetrick noted that school level information
is often unavailable in national data; possibly
masking trends and characteristics. Additionally, the
authors noted the need for common definitions of
violent acts and collecting and disaggregating data
for groups of students is particularly critical (e.g.,
elementary, middle, high school; youth with special
needs and those without). Currently, data collection
is not seen as a simple endeavor and, often, is not
seen as fitting the role of a teacher except in the sense
of academic testing. To be certain, simply collecting
data more frequently or consistently will not
necessarily mean that it will collected for the right
reasons. The future of data-based decision making
rests on our ability to persuade people that the
process provides positive outcomes for all. Our
efforts must focus on both effectiveness and


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efficiency. Efficiency is our vehicle for persuading
initial data collection but it is effectiveness that
ultimately will be required to maintain it (Scott &
Barrett, 2004). How can we demonstrate the impact
of data-based decision making to the masses? For
one, we must advertise our data and make public the
positive outcomes associated with both the collection
of data and its use in affecting decision-making.
When the collection and use of data become
functional for school personnel we no longer will
have issue with persuading people to comply.
The Future of SWPBS Research
The future success of PBS as a framework
for changing behavior is dependent upon our ability
to solve problems related to both process and practice
(Eber, Sugai, Smith, & Scott, 2002). For example,
although the literature at large has identified practices
that provide the greatest likelihood of a positive
effect on student success (Gottfredson & Gottfredson,
1996; Lewis, Hudson, Richter, & Johnson, 2004;
Lipskey, 1991) we still do not have definitive
answers as to why schools are often unwilling to
engage in processes that use such practices, or why in
the face of strong evidence for preventive practices
such as PBS, schools continue to favor exclusionary
and punitive practices that have not demonstrated
success in maintaining safe school environments
(Center & McKittrick, 1987; Sulzer-Azaroff &
Mayer, 1991; Walker et al., 1996). This issue may, in
part, be responsible for the fact that foundational
processes seen as key to successful implementation
and maintenance of PBS, although clearly
demonstrated in other systems (e.g. , business, mental
health), have not been scientifically isolated and
validated in the context school-wide systems of PBS.
It is difficult to generate adequate examinations of
these practices when the larger issue is in getting
schools to adopt them with sufficient fidelity to
produce valid outcomes.
As a science, PBS could benefit from
addressing methods of evaluating its own impact. In
order for PBS to continue to evolve, the field's
efforts at measuring significant outcomes must
expand from simple behavior change to address
broader issues of quality of life and social validity
(Kincaid, Knoster, Harrower, Shannon, &
Bustamante, 2002). At present, there is no
economical method to measure changes in quality of
life associated with behavior support efforts. Some
have suggested the use of rating scales and interviews
or other less laborious methods to realistically
involve schools in their own assessment (Clarke,
Worcester, Dunlop, Murray & Bradley-Klug, 2002).
Kincaid and colleagues (2002) argue that PBS must


assess team member perspectives on behavior
changes so that they may share their views on the
efficiency of PBS strategies. The issue of efficiency
or simplicity continues to be relevant as schools are
asked to take more responsibility for their own
assessment. Realistic research instruments that can
reliably and validly measure quality of life issues
would benefit PBS and study must include an
assortment of information-gathering techniques,
including interviews, rating scales and checklists that
are practitioner- and family-friendly (Lucyshyn &
Albin, 1993; Wood, 1991).
As a compliment to a depth of research
within cases, SWPBS needs a depth of research
across cases. This will require cooperative efforts to
measure and analyze data attained across schools,
districts, regions, and states. Questions of concern
within this approach to research will include
examination of relationships between placement and
behavioral change. Specifically, we need to answer
questions regarding how inclusive settings can be
developed to maximize success for specific
challenges, behaviors, and students.
Kern and Manz (2i 114) have suggested
several steps toward a wider and deeper body of
knowledge related to PBS. These suggestions include
the (1) development of large-group studies to
determine the outcomes of school-wide programs, (2)
determination of the relationship between school-
wide positive support and student academic
outcomes, (3) determination of the relationship
between the improvement in school-wide support and
quality of classroom instruction (4) creation of a
data-base pertaining to all aspects of secondary and
tertiary intervention ranging from implementation to
outcomes, (5) use of single subject designs to explore
effective interventions with children with intensive
needs, and (6) addition of social validity data to
establish the opinions of a wider range of consumers
of PBS.
Although we agree that improving any of
above topics would benefit the field of SWPBS, we
believe that improving social validity represents the
most obvious and immediately beneficial
development. Because PBS is systemic and must
intertwine process and practice, our ability to assess
the perspectives, desires, and beliefs is crucial to our
understanding of the variables that affect and predict
successful adoption of evidence-based practices.
Schwartz and Baer (1991) have set forth three
necessary improvements to socially valid
assessments. First, we must increase the number of
researchers and practitioners who conduct socially
valid assessments and encourage them to report the


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results. Second, a greater number of consumers and
community members must be sampled and, again,
their results reported. Third, objective and reliable
measures must be developed to help researchers
identify human antecedents of effective systems.
They believe that continuing to involve consumers in
the evaluation of both training and research will
result in wider and more acceptance of suggested
interventions. Further, it is hoped that such a shift
may have the effect of increasing the adoption,
fidelity, and maintenance of effective practices into
PBS as part of the typical school process.


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PROMISING DIRECTIONS FOR THE TREATMENT OF COMPLEX CHILDHOOD
TRAUMA: THE INTERGENERATIONAL TRAUMA TREATMENT MODEL
Katreena L. Scott and Valerie E. Copping

Chronic or complex childhood trauma, such as abuse, neglect, exposure to violence or parental criminality, is strongly associated
with the development of criminal behaviors later in life. This paper presents the Intergenerational Trauma Treatment Model
(ITTM), a 21-session, manualized intervention designed to ameliorate the impact of chronic trauma on children's development.
Treatment proceeds in three phases: psychoeducational group sessions for parents; individual sessions to address parental trauma
impact; and finally child and parent intervention to address trauma-related behaviors and symptoms and promote stronger parent-
child relations. Unique features of the ITTM include attention to intergenerational patterns of trauma transmission and focus on
parents as the key agents of change for their children.


The association of childhood trauma and
criminal outcomes in adolescence and adulthood is
robust. Retrospective studies consistently find much
higher rates of childhood trauma and victimization
among individuals who have been arrested or charged
with offences or who report engaging in illegal
activities (e.g. Driessen, Schroeder, Widmann, von
Schonfeld & Schneider, 2006; Grella, Stein &
Greenwell, 2005; van Dalen, 2001; Weeks & Widom,
1998). Prospective longitudinal studies confirm these
relationships. For example, Widom and colleagues
have found that, compared to matched controls,
individuals who have been victimized as children are
more likely to be arrested as juveniles and to engage
in higher rates of self-reported and officially
documented violent and non-violent crimes in
adulthood (Kaufman & Widom, 1999; Maxfield,
Weiler & Widom, 2000; Widom, Marmorstein,
White, 2006).
Findings such as these highlight the urgency
of providing effective treatments for trauma in
childhood so that criminal outcomes can be avoided.
Over the past two decades, treatment for childhood
trauma have evolved from individually-focused
psychodynamic and cognitive models largely
imported from work with adults, to methods that
more appropriately recognize the developmental and
familial context of children's trauma. Treatment
options for childhood trauma now range widely, and
include everything from individual child therapies,
parent training, behaviorally-based parent-child
interaction training, attachment based parent-child
sessions, and trauma-focused cognitive-behavioral
therapy (see reviews by Cohen, Berliner, Mannarino,
2000; Cohen, Mannarino, Murray & Igelman, 2006).
In this paper, we present another promising
model for the treatment of childhood trauma: the
Intergenerational Trauma Treatment Model
(Copping, 1996; Copping, Warling, Benner, &
Woodside, 2001). This model incorporates many of


the features of empirically-supported methods of
treatment including trauma exposure, cognitive
processing and reframing, stress management and
parent education (Cohen, Mannarino, Berliner &
Deblinger, 2000). It differs in terms of its
applicability to complex trauma, the primacy placed
on enhancing the caregiver's capacity to respond to
children's experience of trauma and on its attention
to the intergenerational nature of traumatic
experiences.
Prior to introducing the ITTM, a brief
review of four important aspects of the
conceptualization of trauma that differ between
children and adults is completed. We then provide a
description of the ITTM content, intervention
strategies and therapeutic processes. Finally, we
present a series of arguments to support the proposed
focus of the ITTM on caregivers as critical
contributors to their children's recovery from trauma.
We acknowledge that children have a variety of
primary caregivers and that the people to whom
children naturally turn in times of distress are
sometimes mothers, fathers, adoptive or foster
parents or caregiving relatives. Herein, we use the
terms caregivers and parents interchangeably to
represent these primary relationships.
Unique Characteristics of Trauma in Childhood
The diagnosis of a specific trauma-related
disorder (PTSD) first appeared in the DSM-III in
1980, and was extended to children in the 1987
DSM-III-R. Since that time, models of trauma in
children have developed rapidly and differences
between trauma in children and adults have become
increasingly recognized. Theorists, researchers and
clinicians now acknowledge that children's
experiences of trauma are: (1) often chronic, rather
than acute; (2) associated with a wide range of
symptomatic reactions that only sometimes resemble
adult-based criteria for the diagnosis of PTSD; (3)
significantly impacted by their caretakers response


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and reaction to their traumatic experience; and (4) are
frequently linked to intergenerational patterns of
trauma transmission.
For many children, trauma is not a single,
frightening, unpredictable event, but rather a series of
traumatic experiences (Finkelhor, Ormrod & Turner,
2007a; Terr, 1991; Widom, Button, Czaja &
DuMont, 2005). Results of the CDC's Adverse
Childhood Experiences survey of over 17 thousand
American adults receiving services from a major
Health Maintenance Organization revealed that
chronic traumatic events in childhood are vastly more
common than recognized or acknowledged. Among
this sample of adults, 11% reported having been
emotionally abused as a child, 28% reported physical
abuse, 20% reported sexual abuse, 25% reported
being neglected, 24% reported being exposed to
family alcohol abuse, 19% exposure to parental
mental illness, 12% witnessed mothers being battered
and 27% reported that one or both of their parents
abused drugs. Moreover, exposure to multiple forms
of trauma was more common than exposure to one.
Among adults reporting at least one childhood trauma
(64% of the entire sample), close to 60% reported
exposure to more then one and 20% reported
exposure to four or more types of trauma (CDC;
Felitti et al., 1998). Finkelhor and his colleagues
(2007a) coined the term "poly-victimization" to
describe the experiences of such children and
suggested that for them, victimization is more a
"condition than an event" (p. 9). Others have referred
to this type of trauma as complex or chronic trauma
(Cook, Spinazzola, Ford, Lanktree, Blaustein,
Cloitre, et al., 2005; Terr, 1991).
A second important difference between
children and adults is their reaction to traumatic
events. Among adults, traumatic incidents tend to
produce discrete conditioned behavioral and
biological responses to reminders of trauma
consistent with those captured in the diagnosis of
PTSD. Among children, reactions to trauma are much
more variable and are captured less well by PTSD
diagnostic criteria (van der Kolk, 2005; Spinazzola,
Ford, & Zucker, 2005). Ackerman et al. (1998), for
example, found that among 364 abused children, the
most common diagnoses, in order of frequency, were
separation anxiety disorder, oppositional defiant
disorder, phobic disorders, PTSD and ADHD.
Multiple additional studies have established the
connection of childhood trauma with unmodulated
aggression, poor impulse control, attentional
problems, adolescent substance abuse, eating
disorder, promiscuity, and other problematic
behaviors and symptoms in addition to the primary
symptoms of reexperiencing, avoidance, and anxiety


required for a PTSD diagnosis (van der Kolk, Roth,
Pelcovitz, Sunday & Spinazzola, 2005; Cahill,
Kaminer, & Johnson, 1999; Paolucci & Genuis,
2001; Boney-McCoy & Finkelhor, 1996). These
observations have lead theorists to suggest a new
diagnostic category for chronic childhood trauma
labelled Developmental Trauma Disorder and
characterized by: (1) exposure to multiple or chronic
forms of developmentally adverse interpersonal
trauma, (2) triggered pattern of repeated
dysregulation (either over- or under-regulation) in
response to trauma cues, (3) persistently altered
attributions and expectancies (e.g. distrust of
caregiver, negative self-attribution, loss of
expectancy that others will protect), and (4)
functional impairment (van der Kolk, 2005).
Although there have yet to be published field trials of
this diagnosis in children, the proposed diagnosis of
complex trauma for adults, which has many similar
features, has received preliminary support (Roth,
Newman, Pelcovitz, van der Kolk, & Mandel, 1997).
A third critical difference between
children's and adults experience of trauma is the
importance of caregivers to moderating the severity
and duration of children's trauma-related symptoms.
Studies have consistently found that children who
have a nurturing and supportive relationship with
their parents are less symptomatic following trauma
than children who receive less support from their
caregivers (Adams-Tucker, 1982; Conte &
Schuerman, 1987; Deblinger, Steer & Lippmann,
1999; Freidrich, Urquiza & Beilke, 1986; Scheering
& Zeanah, 2001; Tufts, 1984). In fact, in studies that
have compared the potential influence of multiple
different factors on children's trauma, such as the
characteristics of abuse, identity of the offender and
the frequency and duration of abuse, parental support
consistently emerges as one of the most important
predictors of childhood functioning (e.g. Everson,
Hunter, Runyon, Edelsohn, & Coulter, 1989; Oates,
O'Toole, Lynch, Stem & Cooney, 1994).
Finally, children's experiences of trauma are
unique is in terms of the role played by their primary
caregivers. In cases of chronic trauma, children's
caregivers are frequently direct (e.g. physical abuse,
parental substance use), or indirect (e.g. exposure to
domestic violence) contributors to their children's
trauma (Karr-Morse & Wiley, 1997). Often, such
contributions are part of intergenerational patterns of
trauma transmission. In the field of family violence,
this continuity is referred to as the "cycle of
violence", with studies concluding that about one
third of parents maltreated as children will go on to
abuse or neglect their children (Kaufman & Zigler,
1987). Similar intergenerational patterns have been


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noted for sexual abuse, intimate partner violence,
alcohol and drug addiction, and criminality
(Ehrensaft, Cohen, Brown, Smailes, Chen, &
Johnson, 2003; Lev-Wiesel, 2006; Conger, Neppi,
Kim, & Scaramella, 2003; Fuller, Chermack, Cruise,
Kirsch, Fitzgerald, & Zucker, 2003; Murray, Janson,
& Farrington, 2007). The intergenerational nature of
trauma, along with the importance of caregivers to
helping children regulate and cope with trauma, place
children in a unique, irresolveable negative bind
which has particularly severe consequences for their
ongoing development (Howe, 2005).

Implications for Treatment

Differences between children's and adults'
experience of trauma have a number of implications
for efficacious treatment. As outlined by the
Complex Childhood Trauma working group of the
National Child Traumatic Stress Network,
empirically-validated trauma-treatment models that
focus primarily on reintegration of trauma are
unlikely to be sufficient for chronically and multiply
traumatized children (Kinniburgh, Blaustein,
Spinazzola & van der Kolk, 2005). Instead, this
working group has recommended that treatment of


complex trauma needs to follow a phase-based
approach with six goals: safety, self-regulation, self-
reflective information processing, trauma experience
integration, relational engagement and positive affect
enhancement. They also recommend that treatment


be embedded in a social/contextual framework,
sensitive to development, flexible in its approach and
capable of addressing individual, familial and
systemic needs and strengths (Kinniburgh et al.,
2005).

A variety of models have been developed to
meet these needs, all of which still require rigorous
empirical validation. Examples of programs currently
available include: Structured Psychotherapy for
Adolescents Responding to Chronic Stress (DeRosa,
2004); Trauma Adaptive Recovery Group Education
& Training (Ford, 2006); Real Life Heroes (Kagan,
in press); Assessment-Based Treatment for
Traumatized Children: Pathway Model (Taylor,
Gilbert, Mann, & Ryan, 2006) and the Attachment,
Self -Regulation & Competency Model (Kinniburgh
et al., 2005). There have also been a variety of
treatments suggested for specific types of chronic
childhood traumas such as maltreated and violence-
exposed children (see review by Cohen et al., 2006).
Most of these models combine traditional trauma
intervention components (i.e., psychoeducation,
trauma exposure, cognitive processing and re-
integration of trauma experiences, parent skills


training, stress management) with interventions
aimed at strengthening attachment to caregivers,
peers and others, developing behavioral and
emotional regulation, and improving self-concept
(Cook et al., 2005).


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Table 1: Intergenerational Trauma Treatment Model: Major Therapeutic Activities
Treatment Phase Therapeutic Strategies
PHASEA Psycho-education on a broad spectrum of trauma-related literature
6 group-based sessions attended
by children's caregivers Cognitive-behavioral framework introduced for understanding behavior and for the promotion
of meta-cognition and self-reflection
Caregiver monitoring of self-regulation and of their position relative to the child's need for
understanding and containment
Promotion of self-efficacy through daily monitoring of change
Phase B Cognitive-behavioral processing of traumatic or impactful experience in caregiver's childhood;
Average of 8 individual sessions identification of trauma theme, deconstruction and disputation of the faulty belief system by the
with children's caregivers therapist, attribution of belief to childhood experiences
Implementation of quality 1-on-1 time between caregiver and child (minimum of 3 hours a
week)
Co-development (caregiver and clinician) of hypothesis around the faulty beliefs) system
developed in child as a result of impact of trauma or other impactful event.
Phase C Directed sand tray stories and/or diagrams to address children's relational bond with their
3 to 8 sessions for the child with primary caregivers and for exposure and reconstruction of traumatic experience
the caregiver present.
Cognitive-behavioral processing of child's traumatic experience; identification of dominant
trauma theme, disputation of resulting faulty belief/dilemma for the child, countering of self-
blame
Active involvement of the caretaker as an observer and co-director of the therapy process
As necessary, attachment recreation intervention to address security of relational bond between
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Intergenerational Trauma Treatment Model
(ITTM)
The Intergenerational Trauma Treatment
Model (Copping, 1996) represents an alternate model
for treatment of complex trauma in childhood. It
differs from previous models in its combination of
cognitive-behavioral and psychoanalytically
informed strategies for understanding and intervening
with families and with its focus on parents as the
mechanism of change for their child. The ITTM
consists of 21 manualized sessions and is designed
for parents of children between the ages of 3 and 18.
It was developed in Hamilton, Ontario and currently
being implemented across 14 clinics in Ontario,
Canada (www.traumatreatment.ca). There is an
associated 100-hour structured training program that
includes introduction and training on the model and
ongoing clinical supervision over the first year of
implementation.
The ITTM is offered in three distinct phases.
Phase A is a six-week course entitled The Trauma
Information Sessions. Phase B involves
approximately eight individual parent sessions aimed
at addressing impact of the caregivers' most
traumatic or impactful childhood experience and on
improving caregiver capacity to relate to, and
contain, their children's experience of trauma.
Subsequently, in Phase C, the caregiver and the
clinician are engaged together to provide the child
with between three and eight sessions of trauma
treatment. Main features of each Phase are
summarized in Table 1.
Phase A: Trauma Information Sessions.
Phase A is provided as a series of six 90-
minute sessions presented groups of up to 50
caregivers. Sessions are psycho-educational in nature,
guided by principles of trauma, attachment, and
cognitive behavioral therapy. Specific topics of
presentation include: information on trauma;
differences in the experience of trauma for children
and adults; importance of caregivers to children's
response to trauma; caregivers positioning in their
relationship with their children; thoughts, feelings
and actions associated with cycles of self-defeating
behaviors, and anger and emotional regulation.
Caregivers receive articles, diagrams, charts, and
homework assignments after each session. The
Trauma Information Sessions are designed to achieve
four goals. These are: (1) to develop caregiver
empathy for their child's experience, (2) to reposition
caregivers' to be better able to provide their child
with security and containment, (3) to improve
caregiver self-regulation and disengage them from


conflict with their child, and (4) to develop caregiver
hope, self-efficacy and motivation for change.
Two aspects of the Trauma Information
Sessions distinguish them from other
psychoeducational groups on childhood trauma. A
first important characteristic is the containment
provided to the caregiver. An important barrier to
children receiving treatment for trauma is
dysregulation of the caregiver around the child's
trauma (Kim, Noll, Putnam & Trickett, 2007). With
this in mind, Phase A sessions have been carefully
designed to contain caregiver affect and develop
caregiver's self-regulation. Sessions are offered in a
large group format where parents' capacity to learn is
emphasized. Emotional dysregulation in parents is
contained by restricting opportunities for personal
story telling, co-regulation of caregiver affect by the
clinician, and though the use of diagrams to capture
abstract concepts in a concrete and containable
format.
A second important feature is the level and
intensity of homework assigned. Caregivers attending
Phase A are gradually asked to complete increasing
amounts of homework; first reading, then short
exercises, then charting aspects of their relationship
with their child and finally all previous aspects of
homework plus self-exploration and monitoring.
Homework assignments have multiple functions.
They help parents integrate information being
presented in the information sessions and begin the
process of change. They also place caregivers in the
position of having to commit significant resources to
promoting change in themselves and their families.
Finally, homework exercises act as a screen for
caregivers who are not able to contain their affect
sufficiently to complete homework or commit
sufficient resources to intervention. These caregivers
are then counselled individually or are referred to
another program to develop their capacity to attend
and complete Phase A.
Phase B: Caregiver Treatment Sessions.
Phase B consists of an average of eight
individual sessions with children's caregivers.
Sessions begin with an assessment of caregiver
understanding of material from Phase A and of
possible barriers to caregivers' ability to engage fully
in intervention, such as active addition to drugs or
alcohol, ongoing domestic violence, debilitating
depression or anxiety, or the possibility of separation
of child and caregiver. When there are significant
barriers to caregivers' progress, ITTM treatment will
be paused and specific alternative interventions
pursued (e.g. counselling for addiction).


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Following assessment, caregivers are asked
to identify their most impactful childhood experience.
The caregiver completes detailed diagrams of the
thoughts, feelings and actions associated with this
experience in the past, present and with specific goals
outlined for the future. From these charts, the trauma
theme (e.g., aloneness, abandonment, victimization)
that most aptly captures the salient features of that
caregiver's specific interpretation and experience is
highlighted. The trauma theme then forms the core
material for treatment where the predominant faulty
belief system of the caregiver is identified,
deconstructed, and reconstructed. Caregivers are
guided through the process of re-structuring their
faulty belief systems through deconstruction and
disputation by the therapist and self-monitoring.
Once parents have a full understanding of their own
trauma theme, intergenerational patterns of
transmission of trauma are explored and caregivers
are activity engaged in speculating about how their
own trauma might be impacting the life of their child.
At the conclusion of Phase B, caregivers complete
diagrams to represent their hypothesis about their
children's experience of trauma and how their own
trauma theme may have influenced their children's
interpretation and response. Other key activities of
Phase B include the implementation of quality one-
on-one time between the caregiver and child and, as
necessary, specific training in emotional regulation
and/or therapeutic work to resolve complex caregiver
grief.
Phase B activities have benefits to both the
caregiver and the child including increased empathy,
emotional regulation, and hope for the potential of
breaking intergenerational patterns of trauma
transmission, improvements in children's feeling of
emotional safety and security and corresponding
reductions in child behaviors and symptoms, and
increased positive interaction of parent and child. All
treatment activities are provided in a series of
sequential steps so that if, at any point, the caregiver
has not experienced improvement, the clinician can
review and repeat until the caregiver has experienced
and maintained success in achieving the desired
outcome. Phase B treatment is terminated when the
clinician judges that the caregiver understands and
has made changes in their own faulty belief system,
has empathy for the child's traumatic experience and
resulting understandable behaviors and symptoms,
has successfully disengaged from conflictual
interactions with their child, and has the developed
emotional attunement with the child and the capacity
to provide containment for the child's traumatic
experiences) and symptoms.


Phase C: Child-Therapist Sessions Co-Directed by
Therapists and Caregivers.
Phase C consists of three to eight sessions
for the child with the caregiver present. Each session
begins with a 10-minute meeting between the
therapist and the child's caregiver to review
homework, share observations, and plan for the
session. The child and therapist then work together
for 30-40 minutes on processing trauma and
attachment-related issues while the caregiver
observes. In the final 10 to 20 minutes of the session,
the caregiver and therapist again meet without the
child present to discuss the child's reactions and
revelations during the treatment session, to reflect on
and interpret children's behaviors, and to develop
homework assignments for the intervening week. Just
as the caregiver received support from the clinician to
make positive changes in his/her life experience, the
caregivers' role is now to take the position as a
emotionally attuned, supportive, competent, co-lead
for the child in treatment.
During Phase C, therapists and children
complete six separate narratives covering children's
relationship with their main caregivers and
culminating with their experience and understanding
of at least one traumatic event. Children's ability to
construct narratives is facilitated by use of either a
sand tray with miniature figures (Thompson, 1990) or
with drawings and diagrams. The therapist works
with the child to identify the faulty sense-making (or
faulty believe system) that is developing as a result of
the child's interpretation of the traumatic event,
directly and logically counter faulty sense-making,
and reconstruct the child's beliefs. Caregivers are
engaged in helping children become more aware of
faulty sense-making, monitor their adherence to
faulty beliefs and consolidate positive changes in
their understanding. Additional interventions are
provided, as necessary, to support caregivers in
helping their children regulate their emotion,
interrupt negative behavioral patterns or address
unresolved traumatic grief.
For the majority of children (approximately
75%), the above Phase C activities are sufficient to
correct children's attributions and beliefs and reduce
behaviors and symptoms to non-clinically significant
levels. For a minority, additional interventions are
required. Decisions about additional treatment are
made largely on the basis of children's organization
around attachment and the development of self (as
revealed in children's narratives, parent report, and
therapist observation). Children whose behaviors and
symptoms persist following initial trauma treatment,
and who have issues around attachment and self-


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organization proceed to option 2 exercises of Phase
C. Typically, the background of these children
includes traumatic experience perpetrated by their
primary caregiver, such as physical abuse, profound
neglect, or abandonment by the caregiver once or
multiple times in the children's history, that are likely
to have had a disorganizing impact on the
development of attachment between caregiver and
child.
When such issues are present, the child and
caregiver are engaged in therapeutic activities to
recreate significant attachment events from child's
past. Children and caregivers identify the
development period at which the disorganizing
trauma occurred and then begin to develop stories
about responsive and nurturing caregiver responses to
the child at that developmental period. For example,
for a child with a classically disorganized attachment
to their primary caregiver, intervention would begin
by creative narratives of responsive, available,
nurturing, accepting caregiving in infancy. The child
would then be engaged in playing out these created
stories using sand tray or diagrams and eventually in
role-plays with their caregivers. These interventions
provide the child and caregiver with a chance to "re-
write" the script of the child's life, at least in the
child's experience of their current life context, which
in turn, allows the child to develop greater coherence
and self-organization, builds a foundation for
stronger parent-child relationships, and reduces child
behaviors and symptoms.
Specific Strengths of the ITTM
The ITTM is consistent with many of the
recommendations for treating complex trauma in
children. However, there are important differences
between this model in terms of the level of caretaker
involvement and the focus on issues around
intergenerational transmission of trauma. Each of
these aspects of the ITTM is discussed in turn.
Parents are primary focus of intervention.
The first, and most important, difference
between the ITTM and other treatment models
addressing childhood trauma is the role of caregivers
in treatment. Although the majority of current models
of treatment for childhood trauma include parents,
the ITTM is unique in its focus on the parents as the
primary agents of change for the child. An organizing
assumption of this model is that the people who are
in best position to assess and address their children's
trauma are children's caregivers. As reviewed, the
ITTM begins with information sessions for
caregivers, then takes caregivers through the process
of addressing trauma, and then works collaboratively


with the parent to address their child's trauma. As
such, one focus of intervention is on promoting
parents' capacity for, and confidence in, addressing
their children's trauma and related behaviors and
symptoms (i.e. self-efficacy and empowerment). This
practice contrasts significantly with the more typical
practice of involving parents as informer to the
therapist (e.g. individual children interventions that
include a short meeting with children's caretakers to
get updates on children's behaviors and progress over
the week); supporter of the therapy (e.g. interventions
that provide information to caretakers about
children's problems and give them tasks to complete
at home that will support work being done with the
child individually); or co-participant in the therapy
(e.g. parents and children hear the same information
and work together on developing similar skills) (Hill,
2005).
There are multiple reasons for focusing on
parent as the primary agent of change for children
including the importance of parents for facilitating
children's access to therapy and empirically-
documented benefits for improved child outcome
(Jones & Prinz, 2005; Webster-Stratton & Hammond,
1997; Webster-Stratton, Reid & Hammond, 2004).
However, perhaps most importantly, focusing on
caregivers the primary targets of treatment has the
benefit of retaining them a position of capability and
mastery relative to their child. This aspect of parental
involvement has been emphasized in research on the
importance of parental self-efficacy and parental
empowerment to child outcomes (Jones & Prinz,
2005; Hoagwood, 2005) but is likely of even greater
importance to children who have experienced trauma.
One significant impact of trauma on children
(as well as adults) is compromised sense of safety
and security in the world. For infants, toddlers,
school-aged children and adolescents, the main
source of felt and actual security in the world comes
from caregivers. In the face of a threat to one's sense
of security, children turn to their primary caregivers
to help understand and cope with concerns about
their security and with emotions that arise from the
threat to their felt sense of safety in the world.
Attachment theorists originally emphasized
the importance of parents to children's sense of
safety in the world. Although often understood as
relevant only in infancy, attachment theorists
emphasize that individuals' attachment and working
models of relationships continue to differentiate over
time (Cicchetti, Toth & Lynch, 1995) They further
emphasize that particular events are likely to prompt
re-evaluation and re-organization of attachment-
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trauma represents one such event. Conceptualizing
trauma as a challenge to the primary attachment
relationship is obvious in cases of abuse or neglect of
an infant or very young child by their primary
caregiver, or in families where infants are receiving
their primary care from a caregiver suffering from
alcoholism, suicide attempts or criminality (Hughes,
2003; Liebermann & Knorr, 2007). However, even
when traumatic events are independent of children's
caregivers (e.g. sexual abuse by a neighbour),
children turn to their primary caregivers following
trauma to help them regulate overwhelming emotions
and regain their sense of safety and security in the
world. If their caregivers are unable to assure them of
safety and help them regulate their emotion, then
children are likely to lose confidence in the security
of their bond with their caregiver and begin to re-
evaluate their working models of relationships (i.e.,
"I thought that this was a person who could protect
me, but maybe I am all alone and cannot rely on
anyone to understand me and make me feel safe").
Since traumatic events challenge the
relational bond between children and their primary
caregivers, one aspect of treatment needs to be
addressing possible disruptions in the security of the
relationship between children and their caregivers;
specifically, ensuring the caregivers are adequately
attuned to their children and that they are effectively
co-regulating their trauma related affect (Kinniburgh
et al,. 2005). Given this therapeutic goal, retaining
parents in their position of capability and mastery
relative to their children may be a particularly
valuable therapeutic intervention for these children.
In the ITTM, caregivers' position as the
secure foundation for children is promoted in a
number of ways. First, the importance of parents to
children is directly affirmed by having parents attend
therapy without their children first, and then by
involving parents as participants and co-directors of
their child's therapy. Children are only seen alone for
the purposes of assessment, and in possible cases of
emergency or crisis intervention (e.g. child or
caregiver reports child suicidal intent or
maltreatment). Second, parents are directly taught
skills for skills needed to improve caregiver
attunement with their child and promote co-
regulation of children's trauma-related emotion.
Finally, parents are engaged in co-directing the
therapy given to children, so the therapeutic benefits
can be obtained without disruption of this critical
relationship. In these ways, the ITTM helps the
parent regain, or retain, their position as the safe base
for their child in their dealing with trauma. Similar
goals for intervention (though with different
activities) are emphasized for infants and young


children with attachment disorders, or at-risk for
attachment disorders (Madigan, Hawkins, Goldberg
& Benoit, 2006; Lieberman & Van Horn, 2005,
Lieberman, Van Horn & Ippen, 2006), but have
seldom been carried forward into work with older
children and adolescents.
Recognition of the Intergenerational nature of
trauma.
A second unique feature of the ITTM as a
method for treating trauma is its explicit recognition
of the strong intergenerational component to the
experience of trauma in families. As previously
reviewed, the existence of intergenerational cycles of
trauma is well established in the empirical literature.
Thus, chronically traumatized children may be
reacting to trauma perpetrated by one or more of their
primary caregivers. Alternatively, non-offending
parents with unresolved trauma in their own
childhood may be caring for children.
In families where cycles of violence are
being repeated, or where early attachment between
parent and child is compromised due to particularly
severe unresolved trauma impact in the caretaker,
poor parental responsiveness to children's trauma
might be expected. These parents are particularly
unequipped for the inter-subjectivity and attunement
necessary to help resolve behaviors and symptoms
associated with children's exposure to trauma
(Hughes, 2003). Moreover, due to ongoing
challenges to the parent-child relationship, children in
these families are likely to respond to trauma with
particularly high levels of behaviors and symptoms,
further increasing the challenge to their primary
caregivers to maintain empathy, attunement and
containment (Kozlowska, 2007).
Even when cycles of violence are avoided
and early parent-child attachment is secure, parents
with unresolved trauma in their history may have
specific deficits in terms of their ability to respond
effectively to their children's trauma. Unresolved
maternal trauma has been associated with deficits in
maternal sensitivity and responsiveness, higher levels
of maternal harshness, and with a variety of problems
in adaptation, such as depression, anxiety, PTSD and
addiction that reduce their ability to respond
empathetically to their children (Kim, Noll, Putnam,
& Trickett, 2007; Schechter, Zygmunt, Coates,
Davies, Trabka, McCaw, et al., 2007). More
specifically, because of their unresolved traumatic
experiences, these parents are likely to react to their
children's trauma with particularly high levels of
their own distress and/or have restricted emotional
awareness around certain aspects of children's
emotional experience (Hughes, 2003; Nader, 1998).


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A child's needs following trauma can also trigger a
caregiver's own memories of loss, rejection,
abandonment, abuse or diminish their parenting
abilities.
Caregivers with a history of exposure to
political trauma such as the holocaust, war, genocide,
political persecution, or cultural subjugation may fit
this pattern of responding. These parents often know,
in a way that others do not, that the world can be a
dangerous place and that humans are capable of
sadistic and indifferent cruelty and feel a
corresponding imperative to keep their children safe
from harm. As a result, these caregivers may be more
easily overwhelmed by their children's exposure to a
traumatic event, particularly if their children's
traumas share any characteristics with their own
experience (Wiseman, Metzl & Barber, 2006). Even
in the context of a secure attachment between child
and caregiver, these parents may be unable to identify
with their children's fears (which will likely be very
different from their own) or regulate their emotions
to a sufficient degree to provide containment for this
child (Yehuda, Halligan & Grossman, 2001). Thus,
children of these parents may feel abandoned or
criticized following trauma exposure, and develop
behaviors and symptoms reflecting both trauma
experience and insecurity, guilt and fear resulting
from their parents' lack of attunement and
containment following the trauma exposure.
Ironically, the intergenerational nature of
trauma has often led to recommendations that parents
not be included in their children's treatment.
Specifically, parents' poor self-regulation and
compromised attunement with their child have been
seen as a significant detriment to therapy. For
example, Sperling (1997) suggests that parents who
are unable to use input, reject therapists' initial
suggestions, or who are likely going to be a challenge
to therapy and are best left uninvolved in children's
treatment. In their integrated parent-child CBT
approach, Runyon et al. (21" '4) suggest that children
should be encouraged to share their trauma narratives
with their caregivers only "if clinically appropriate"
(p. 76). The ITTM takes the opposite position - that
the weakening of the relational bond between parents
and children is likely a key contributor to children's
trauma-related behaviors and symptoms and that
addressing parent's trauma is a critical part of
treatment for children. In fact, from a relational
standpoint, it may be argued that the most important
parents to include in treatment are those with
unresolved trauma so that security in the parent-child
relationship can be developed or repaired alongside
treatment children's trauma-related cognitions and
reactions.


The ITTM addresses the intergenerational
nature of trauma in two main ways. As previously
discussed, both the structure and content of the ITTM
is designed to help parents build or regain a strong
relational bond with their child so that they are better
able to provide a secure holding environment for
their children's trauma and related behaviors and
symptoms. The ITTM also recognizes that many of
the caregivers attending intervention will have
difficulties regulating and experiencing their own
trauma-related affect. For this reason, once caregivers
have gone through Phase A and developed an
understanding of their importance to their children's
emotional security, motivation to be this secure base,
and efficacy for change, individual sessions are held
with the therapist and the parent to help address
unresolved trauma impact in the parent (Phase B).
Treatments offered in this phase are designed to both
reduce the impact of intergenerational trauma and to
provide caregivers with a model for working
therapeutically with their child to resolve trauma in
Phase C.
Conclusions
Empirically validated treatments for
complex, chronic childhood trauma are critically
needed. A survey of the practice of a large number of
clinicians treating childhood trauma estimated that
78% of children on clinician caseloads have been
exposed to multiple and/or prolonged trauma.
Although a common presenting pattern, there was
very little consistency in the treatment approaches
used for this population. Common treatments for
children included individual weekly sessions, coping
or self-management skills training, parent-child or
family therapy, play therapy and expressive
therapies, with no clear consensus among clinicians
regarding the relative effectiveness of available
modalities (Spinazzola et al., 2005). Results such as
these have prompted initiatives to improve
consistency and efficacy of practice with chronically
traumatized children. Most notably, the Complex
Childhood Trauma working group of the National
Child Traumatic Stress Network has developed a
series of recommendations for general areas of
intervention and is actively promoting research in this
area (Kinniburgh et al., 2005).
The Intergenerational Trauma Treatment
Model is one promising method of intervention for
complex childhood trauma. This model is consistent
with recommendations of the Complex Trauma
Working Committee and has the advantage of
providing clinicians with a manualized, phase-based
method of reaching treatment goals. The model
includes activities addressing the attachment between


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child and caregiver, regulation of caregiver and child
affect, safe expression and processing of trauma
experiences and the development of parents'
competencies and self-efficacy. Psychoeducational,
cognitive-behavioural and attachment-informed
strategies of intervention are employed. The ITTM
also advances the field in terms of its focus on the
primacy of parents to children's change and on
directly addressing the intergenerational nature of
trauma.

Research on the ITTM is proceeding. A
study of pre- to post-treatment change established
that completion of the ITTM is associated with
significant reductions in child conduct disorder,
problems in social relations and caregiver depression
(Copping et al., 2001). Ongoing research explores the
efficacy of ITTM as compared to treatment-as-usual
and is examining mechanisms of change for children
and caregivers. Such research will continue to be
critical to advancing the field of treatment for chronic
childhood trauma and for helping identify critical
components of chronic trauma intervention.

Continued improvements in treatment for
childhood trauma are likely to have important
impacts on rates of juvenile and adult criminal
behavior. One of the few empirically rigorous
prospective studies of the impact of reducing
childhood trauma on criminal outcomes is the Elmira
study of home visitation by Olds and colleagues.
Results of this ongoing longitudinal study have
confirmed that prevention and early intervention for
child abuse and neglect has very meaningful impacts
on children's criminality. At 15 years of age, for
example, children without intervention were 10 times
as likely to have been adjudicated as a person in need
of supervision and twice as likely report having been
arrested. Effects were even more pronounced among
youth born to low-SES unmarried mothers (Olds et
al., 1998) and among those where maltreatment was
successfully prevented (Eckenrode et al., 2001).
Clearly, further efforts and investments need to be
made to address chronic childhood trauma to thereby
prevent criminality in adolescence and adulthood.

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CASE FORMULATION WITH SEX OFFENDERS: AN ILLUSTRATION OF
INDIVIDUALIZED RISK ASSESSMENT
James Vess, Tony Ward, and Rachael Collie, Victoria University of Wellington

There has been a rapid expansion of the professional literature in risk assessment with sexual offenders over the past 20 years.
However, recent professional experience suggests that risk assessment reports often fail to be as relevant or useful as they might
be for judicial decision-makers. Research with large samples of offenders has refined our understanding of identifiable subgroups
with different rates of sexual reoffending, but the management of risk requires that we deal effectively with individual offenders.
One area that can be improved is the development of case formulations of risk. Clinicians must move beyond the mechanical use
of actuarial static and dynamic risk factors to a broader integration of relevant information about the individual if they are to
assist in managing risk in a way that serves the needs of the offender while protecting public safety.


The advent of a controversial new
generation of legislative initiatives aimed at
increasing public protection from high risk sexual
offenders has helped to stimulate a rapidly expanding
research literature in the area of risk assessment.
Despite significant advances in the field's
understanding of various factors associated with
higher risk for sexual reoffending, clinical experience
to date suggests that significant improvements can be
made in the formulation and reporting of risk by
mental health professionals. A separate article
addressed the broader issue of case formulation as
part of the comprehensive assessment of sexual
offenders, primarily for the purpose of treatment
planning (Collie, Ward & Vess, in press). In brief, a
case formulation is a conceptual model representing
an offender's various problems, the hypothesized
underlying mechanisms, and their interrelationships
that is clearly linked to contemporary theory and
research. A case formulation specifies how the
symptoms or problems are generated by
psychological mechanisms, for example,
dysfunctional core beliefs or behavioral deficits.
Furthermore, a case conceptualization provides a
rational basis for determining treatment needs that
can be used to tailor interventions with offenders in
the aim of achieving optimal outcomes.
In this article the focus is more specifically
on case formulation in risk assessment. The goal is
to illustrate a process that moves from the mechanical
assessment aspects of using actuarial measures,
combined with consideration of empirically grounded
dynamic risk factors, to the development of a
thorough and integrated case formulation that
provides an etiological explanatory framework for
understanding risk in an individual sexual offender.
First a brief review of the measures and risk
factors currently considered to represent best practice
standards in sex offender risk assessment is provided.
Drawing on this foundation, the nature of etiological


case formulation is presented. This is followed by a
few considerations in reporting risk. The challenge
here is to communicate the findings of the formulated
risk assessment in an effective manner so as to be of
assistance to those making use of the assessment
results, such as the courts, parole boards, or other
judicial decision-makers. Finally, two case examples
derived from clinical forensic experience are used to
illustrate the utility of case formulation in sex
offender risk assessment.
Elements of current best practice
Static factors. There is a current consensus
in the assessment field that actuarial measures have
demonstrated a statistically significant level of
predictive accuracy regarding the risk of sexual
reoffending, and consistently outperform clinical
judgement in this respect (Abracen et al., 2004;
Borum, 1996; Miller, Amenta, & Conroy, 2005;
Barbaree, Seto, Langton, & Peacock, 2001; Hanson,
1998; Hanson & Thornton, 1999, 2000). Actuarial
measures function by placing individual offenders
into groups with known reconviction rates, so that
individual risk estimates are based on observed group
outcomes. Examples of such measures with research
evidence of predictive validity include the Violence
Risk Appraisal Guide (VRAG) (Harris, Rice &
Quinsey, 1993), the Sex Offender Risk Appraisal
Guide (SORAG) (Quinsey, Harris, Rice, & Cormier,
1998), the Rapid Risk Assessment of Sexual Offense
Recidivism (RRASOR) (Hanson, 1997), and the
Static-99 (Hanson & Thornton, 1999). Actuarial
measures such as these form the foundation of the
best-validated risk assessment procedures currently
available.
One of the actuarial measures with the most
empirical support is the Static-99 (Hanson &
Thornton 2000). Doren (21" 4) notes that there have
been at least 22 studies of the Static-99's predictive
validity beyond the Hanson and Thornton (2000)
developmental study. In a recent development,


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Thornton et al. (2003, as cited in Craig, Beech &
Browne, 2006) developed a risk assessment system
referred to as the Risk Matrix 2000/Sexual. This new
measure looks promising, but has not yet been as
widely validated as the Static-99.
Dynamic factors. Standard practice in sexual
offender recidivism risk assessment also includes
consideration of dynamic factors that can change
over time and influence the degree of risk for
reoffending. Douglas and Skeem (2005) make a
conceptually important distinction between risk
status, which they define as inter-individual risk level
based on static risk factors, and risk state, defined as
intra-individual risk level determined primarily by
the current status of dynamic risk factors. The role of
intra-individual variables has particular relevance for
case formulation. Variations in risk over time will be
primarily influenced by these dynamic factors, and a
clear understanding of their function will be crucial
for effective risk management. The refinement of
empirically validated models of dynamic risk should
assist not only in the prevention of sexual
reoffending, but in the reduction of other forms of
violence as well.
The Sex Offender Need Assessment Rating
(SONAR) is an actuarially based measure of dynamic
risk factors empirically related to rates of sexual
recidivism (Hanson & Harris, 2000, 2001). The
SONAR allows clinicians to evaluate changes in
dynamic risk factors over time across the two
domains; five stable dynamic variables (intimacy
deficits, negative social influences, attitudes tolerant
of sex offending, sexual self-regulation, general self-
regulation) and four acute dynamic variables
(substance abuse, negative mood, anger, victim
access). A recent development based on the SONAR
is the STABLE 2000 (Harris & Hanson, 2003, as
cited in Harris, 2006), which adds the variable of
cooperation with supervision.
Combining measures. Recent research on
sex offenders has shown that risk predictions made
by static actuarial measures can be improved by
incorporating dynamic variables to give a fuller
picture of individualized assessment of risk (Craig,
Browne, & Stringer, 2004; Craissati & Beech, 2005).
A recent review of the effectiveness of sexual
recidivism risk assessments found that structured
clinical judgement, where a clinician makes a
prediction of risk guided by an appropriate actuarial
measure, combined with dynamic variables
individual to an offender, showed good predictive
accuracy (Hanson & Morton-Bourgon, 2005).
Furthermore, Webster, Hucker and Bloom (2002)
contend that combining validated actuarial measures


with empirically based dynamic variables allows for
greater clarity not only for the clinician but also for
decision makers. When important decisions about
the release of offenders (or any special conditions
imposed upon release) are made, it is no longer
considered sufficient to reference a large
heterogeneous population to which an offender
belongs, or even a specific subset of similar offenders
with a known rate of sexual recidivism. A more
complete picture of the offender is being requested
by criminal justice professionals and decision makers
(Dvoskin & Heilbrun, 2001; Monahan, 2004).
Limitations of actuarial measures. We agree
that the use of purely static actuarial measures is
insufficient for a comprehensive risk assessment
because it fails to address the multiple goals such an
assessment is designed to achieve (i.e., treatment
planning, treatment evaluation, parole evaluations,
and so on). While such measures are effective in
placing an individual offender within a specified
group with similar characteristics for which there is a
known rate of sexual recidivism, they do not permit
an individualized formulation of the specific
contingencies and risk factors operating in a given
case. Hanson and Thornton (1999) note that without
the inclusion of dynamic variables, the Static-99
alone cannot determine when sexual re-offending
may occur, or what conditions may precipitate such
an offence. Static actuarial risk measures therefore
do not facilitate an approach to the active
management of risk for individual offenders.
Moreover, because they are by definition static and
unchanging, they do not allow for the assessment of
changes in risk over time, and thereby do not assist in
the judicial decisions about release or supervision
that must be routinely made by judges and parole
boards.
What is needed is an individualized risk
assessment which provides an aetiological (i.e.,
causal) understanding of the factors contributing to
sexual offending in a given case, but that is primarily
grounded in the relative risk of reoffending based on
a recognized actuarial measure. Such an approach
will also incorporate other factors known to be
associated with risk of sexual reoffending.
Deviant arousal and psychopath. Beyond
the static risk factors covered by measures like the
Static-99, and the dynamic factors covered by the
SONAR, two other factors are conclusively
associated with higher risk of sexual reoffending.
Research has consistently shown that psychopathy
and deviant sexual arousal are predictive of increased
risk for sexual reoffending, especially in combination
(Hanson & Morton-Bourgon, 2005; Olver & Wong,


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2006). In a recent study Hildebrand, de Ruiter and de
Vodel (21i 14) examined the sexual recidivism rates
among a sample of treated rapists. They reported a
sexual reconviction rate of 82% over an average
follow-up of 11.8 years for offenders who were both
psychopathic and sexually deviant, compared to 18%
for offenders who were both non-psychopathic and
non-deviant. Similar outcomes have been observed
with other samples including child molesters (Rice &
Harris, 1997).
Factors not empirically associated with
sexual reoffending. In Hanson and Morton-
Bourgon's (2005) large review of the research
evidence related to sexual reoffending found that
several factors often assumed to influence risk were
in fact not related to sexual recidivism. These factors
included lack of empathy for victims, denial of sexual
offending, minimization of sexual offending, and
lack of motivation for treatment. Such factors may be
considered important in an individual case, but they
must be convincingly incorporated into the
formulation of risk as explanatory mechanisms for
sexual offending. It is not sufficient, in light of
current research, to simply list the presence of these
factors as indicators of increased risk.
Identification of risk factors within an etiological
framework.
Optimal risk assessment and management
requires the extension of case formulation skills,
whereby risk factors are identified within an
etiological framework (Ward & Beech, 2006). While
it is important to be aware of the static and dynamic
factors associated with a given type of risk, these
factors are most useful for risk management purposes
when they are formulated into a coherent set of inter-
related causal mechanisms. This requires
examination of several categories of contributing
factors, including historical (e.g. offence history, past
episodes of violence, previous treatment compliance
and response, performance under supervision or
parole), developmental (e.g. adverse developmental
events, nature of family relationships, attachment
style), cognitive (e.g. level of intelligence, cognitive
distortions, attitudes supportive of criminality or
violence), personality (e.g. psychopathy, or traits
such as impulsivity and hostility) and clinical (e.g.
psychiatric diagnosis, level of functioning, substance
abuse).
An especially important element in an
etiological formulation is an individual's personality
features. It has been suggested that focusing on traits
may be a more effective approach than personality
disorder diagnosis, given the overlap in diagnostic
criteria and the commonality of such relevant features


as antagonism, hostility, and impulsivity (Beech &
Ward, 2004). Personality disorders in general and
psychopathic features in particular have been
included in several well established risk assessment
schemes (e.g. HCR-20, LSI-R, SONAR, SORAG).
Such personality features represent not only a marker
of risk level in some contexts, but also bear on issues
of treatment responsivity and the selection of
treatment and case management approaches. Clinical
and case management issues as the client's ability to
establish rapport, maintain a therapeutic alliance, and
develop trust or empathy as mechanisms of change,
will all hinge largely on the personality features of
the individual client.
In light of these individual factors, it is
important to recognize that risk is contingent upon
current situational or contextual variables (Doren,
2002). Even high risk cases will not be at extreme
risk at all times, but will vary in their likelihood of
reoffending depending on such factors as access to
victims, current degree of alcohol or drug use, access
to and compliance with treatment and supervision
services, the nature of interpersonal relationships and
support systems, and current mood states. Thus
different individuals who have similar profiles in
terms of their scores on various risk assessment
measures will not necessarily respond in a similar
way to the same interventions or risk management
plan. The recidivism risk at any given time will
emerge from an aetiological process determined by
the interaction of individual characteristics and
contextual factors.
One advantage of communicating risk
estimates as probabilities based on groups of similar
offenders is that it provides an explicit
characterization of the risk of reoffending. To say
that an offender belongs to a group in which 15%
have sexually reoffended at 10 years following
release from prison gives a relatively clear
understanding of the level of reoffending that has
occurred among similar offenders. This level of
explicitness or clarity is potentially diminished
through the use of categorical labels such as high,
medium or low risk. The use of such labels is
comparative; a group or individual presents as high,
medium or low risk compared to some other group or
individual. The information that is often not made
explicit is, "compared to whom?" When compared to
non-offenders, most sexual offenders will present a
significantly higher risk of reoffending. Injudicial
decision-making, the concern is more likely to be
how an individual offender compares to other
offenders. So the question arises of how to best
apply labels to well-defined groups of offenders in


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order to convey to the court the relative level of risk
for specific types of reoffending.
An important practical issue concerns what
level of risk represents the threshold for actions such
as applying a special sentence or denying release.
While these are clearly judicial decisions, it may be
more useful to the court to have explicit information
on the relative risk presented by an individual
offender rather than merely a categorical label or
information concerning a specific re-offense rate in a
group of similar offenders. This can be facilitated
only through the development of an individualized,
etiological formulation of risk that is based on the
relevant research but also incorporates multiple
factors into a contingency-based, causal explanation
of sexual offending. Risk assessments should state as
clearly as possible the recognizable contingencies
that will influence the degree of risk present. The
report should specify primary causal conditions, the
most likely victims, and the likelihood and severity of
harm of subsequent offences.
Case Examples
Case 1. Mr. Smith is a 33 year old male of
European-American descent who is currently serving
a prison sentence for the sexual assault of an adult
female. His first conviction was at age 23 for
damaging property. He now has a total of eight
convictions, including shoplifting, theft, assaulting a
fellow inmate, the current rape and wounding with
intent to commit Great Bodily Harm, and setting fire
to a holding cell while awaiting trial for the current
rape. He was also acquitted on a prior charge of
raping his girlfriend, then seven months pregnant.
Mr. Smith experienced an unstable early
environment and developed behavioral difficulties
from an early age. He was raised by his maternal
grandparents after his parents separated due to
violence in their relationship. Mr. Smith had little
contact with his father, who was diagnosed with
schizophrenia and apparently required a supervised
living arrangement of some sort. Mr. Smith did
poorly in school, was disruptive and distractible, and
left without graduating. He began to use cannabis
during childhood, and moved on to the abuse of
inhalants, alcohol and possibly other drugs during his
teens. He may therefore have a genetic vulnerability
to serious mental illness, exacerbated by heavy
substance abuse beginning at a time when his central
nervous system was still developing and particularly
susceptible to the damaging effects of these
substances.
These factors contributed to the
development of a psychotic disorder in his late teens.


His condition has been variously diagnosed as
different forms of schizophrenia, bipolar disorder
with mania, drug induced psychosis, and more
recently as schizoaffective disorder. He has also
been described as having an impulse disorder,
personality disorder characterized by antisocial
features, and a persistent substance abuse problem.
His mental state at the time of his index
offences was clearly impaired. It appears that he was
acutely intoxicated from drug use. The degree to
which his pre-existing psychiatric disorder also
contributed directly to his offence related cognitions
and behaviors is less clear, although his subsequent
accounts of these offences have remained
inconsistent and bizarre, suggesting that his psychosis
prevents him from having a coherent and accurate
understanding of his actions at the time of the
offences. He has been consistently described as
having little or no insight into the nature and
consequences of his offences.
Mr. Smith was assessed using the PCL-R,
scoring in the high range. This assessment found
psychopathic traits such as a callous, self-serving
lack of remorse, a lack of empathy, marked
impulsivity and poor behavioral controls that may
contribute to a higher risk for reoffending. Such
features are evident in Mr. Smith' vicious assault and
opportunistic rape of his victim, a stranger he
accosted in a public park. Furthermore, Mr. Smith
does not accept responsibility for his behavior, lacks
realistic long term goals, has a grandiose sense of
self, and does not modify his behavior as a result of
experience, all of which contribute to a lower
likelihood of positive treatment outcomes.
Mr Smith continues to have treatment needs
in the areas of alcohol and drug abuse, violence
propensity, offence-supporting cognitions,
impulsivity (including sexual and general self-
regulation), and possible sexual preoccupation,
especially when disinhibited by drugs or alcohol. He
also needs to develop sufficient understanding and
acceptance of his mental illness to gain the skills
necessary to assist in the management of his
psychiatric symptoms, which appear to contribute to
his risk for violent or sexual reoffending. These
skills would include recognizing the need for and
complying with long-term use of psychotropic
medications, recognition of the precursors to
psychiatric decompensation (e.g. grandiose or
paranoid ideation, feedback from others regarding
unusual thoughts or behaviors), and the exacerbating
effect that drugs and alcohol have on his mental state.
Unfortunately Mr. Smith's current mental
status and level of insight is impaired to the degree


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that interventions to address these needs remain
impractical. Although he has recently been more
compliant with prescribed medication, has apparently
refrained recently from substance use while
incarcerated, and is less of a management problem
than earlier in his sentence, he still does not
recognize the delusional nature of his belief system
about his index offending, and he is at best
ambivalent about the need for ongoing medication or
treatment following his release. Until such time as
Mr Smith's overt psychiatric symptoms are
sufficiently suppressed and he accepts the need to
engage in treatment to address his relevant needs, it is
unlikely that such interventions will be effective at
reducing his risk of reoffending.
The Static-99 placed Mr. Smith in the
moderate-high range, whereby 33% of the original
research sample in this range were reconvicted for a
sexual offence within five years of release. This
rating may in fact provide an underestimation of Mr.
Smith' actual risk, based on several prior allegations
of sexual offending that were apparently not
prosecuted because of Mr. Smith' extensive
involvement in the mental health system. Had the
sexual offences attributed to him in his psychiatric
records resulted in criminal charges, his Static-99
score would be in the high range, with associated
sexual reoffending rates of 39% at five years, 45% at
10 years, and 52% at 15 years post-release for
offenders in this category.
Additional risk factors contribute to Mr.
Smith' level of risk for violent or sexual reoffending.
These include self-regulation problems, employment
instability, substance use, conflicts with intimate
partners, and attitudes tolerant of offending. When
pressed on the matter of treatment, if it were to be
stipulated as a condition of release, Mr Smith agreed
reluctantly that he would undertake the required
treatment, as long as it did not place him under too
much pressure. He asserted that he would much
rather "get a good job" and make "some decent
money". Mr Smith's employment history and
psychiatric condition suggests that this is not
currently realistic.
Prior reports also suggest a consistent
pattern of sexual preoccupation and poor judgment
about interpersonal boundaries and relationships.
These concerns are further compounded by periods of
apparent delusional grandiosity, when he has been
reported to believe that women love him, desire him
sexually, and want to have babies with him. The
influence of these factors do not appear to have
changed substantially over several years, and
continue to contribute to an elevated level of risk.


The level of risk for Mr. Smith is also
influenced by his psychiatric condition. Although the
presence of schizophrenia or psychotic disorder does
not appear to contribute significantly to the risk of
violence in studies conducted with large numbers of
offenders, the specific form that the mental illness
takes can contribute to risk in individual cases. In
light of his subsequent accounting of events, it
appears that Mr. Smith was acutely delusional,
severely impaired by drugs, or some combination of
both at the time of his index offending. Regardless of
the specific etiology of his impaired psychiatric state,
it was directly related to the perceptions, emotional
states, and cognitions that led to the assault and rape
of the victim. He continues to maintain that the
offence was part of a pre-planned and mutually
agreed upon scheme between himself and the victim.
To the degree that he remains vulnerable to such
psychiatrically impaired perceptions and beliefs, the
risk for similar unfortunate outcomes is higher.
It is likely that Mr. Smith's condition is
chronic, and that the personality, cognitive, and
psychiatric traits that he has long manifested will
continue to prevent his effective participation in
interventions that allow him to more effectively
manage his own level of risk. In light of the probable
course of Mr. Smith' condition and the associated
risk that he presents, a comprehensive case
management plan based primarily on external
monitoring and supervision will be required if he is to
released from prison without posing a significant
threat to public safety. In preparation for that
outcome, focused and sustained efforts should be
made to facilitate compliance with prescribed
medications to control the psychiatric symptoms that
contribute to his risk.
The nature of Mr. Smith's living and
supervision arrangements following release will
therefore be crucial to his chances of a successful
transition to the community and maintaining an
offence-free lifestyle. It will be essential that he is
provided ongoing psychiatric management, including
the availability and monitored administration of
prescribed medication. It must be emphasized that
there continue to be serious doubts about Mr Smith'
ongoing voluntary compliance with treatment
requirements, and without such compliance he has
previously demonstrated rapid and significant
deterioration in his mental status with a
corresponding increase in his risk for violent or
sexual offending. He will have to avoid the use of
recreational drugs and carefully control any use of
alcohol (abstaining would be optimal). He should
have the opportunity to develop a pro-social support
network and appropriate interpersonal and sexual


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relationships. For this to occur, he will need
intensive and ongoing guidance, support, and
supervision.
Finally, it is suggested that Mr. Smith's
level of risk is primarily due to factors that may not
change substantially between now and the end of his
sentence in three years. If a process for
accomplishing the transition of his supervision and
management, including his psychiatric case
management, into the community is not already
underway at that time, it is anticipated that he will
present essentially the same level of risk that he does
currently. While retaining him in prison will
continue to protect the public, it will not in itself
ultimately contribute to the reduction of his risk at
whatever time he is released. At that point, the
adequacy of the supervision, psychiatric
management, and support in the activities of daily
living will be central to his chances of reoffending.
Discussion of Mr. Smith. Although many
sex offenders identified by recent community
protection initiatives such as the Sexually Violent
Predator laws do not suffer from conditions of major
mental illness, this case represents a common
scenario in forensic psychiatric settings, whereby risk
for sexual reoffending is compounded by a persistent
Axis I disorder and attendant concerns about
treatment compliance. The long-term goal is
typically to adequately control psychotic symptoms
to allow the development of internalized risk
management skills. It is hoped that this will allow
eventual reintegration into the community under the
least restrictive conditions, whereby the individual
can achieve the basic human needs for a fulfilling life
while not putting the public at undue risk. The reality
is often that limited treatment responsivity and
inadequate community support resources will mean
that risk management will rely primarily on external
supervision and monitoring. The goal then becomes
one of developing a continuing care plan that allows
for a highly structured and adequately monitored
transition from incarceration or involuntary inpatient
treatment into the community. Knowing the broader
needs of the individual in an etiologically informative
framework can best serve in the development of such
a plan.
Case 2. Mr. Jones is a 41 year old male of
European-New Zealand descent is currently serving a
sentence of Preventive Detention following his
conviction for kidnapping, sexual violation, and
indecent assault upon a 15 year old male. In this
incident, Mr Jones approached the victim and
induced him to get into his car. He then drove to a
secluded area and became physically assaultive,


striking the victim repeatedly across the face. He
then fondled the victim's penis, despite his resistance,
and digitally penetrated the victim's anus. Mr. Jones
finally drove to the victim's home address and
released him, threatening to have him killed if he
reported the incident.
This offence represents a significant
increase in the level of violence compared with
previous sexual offences. Mr. Jones has a pattern of
offending sexually against pre-adolescent and
adolescent males, with six convictions for indecent
assault from the age of 18 until his current offence at
age 29. He has also acknowledged an earlier onset of
offending and a more extensive number and type of
offences than those reflected in his criminal
convictions. In addition to his sexual offences, he
has previous convictions for a variety of property and
fraud offences.
Mr. Jones reports being doted on and
materialistically overindulged as a child by his
mother and grandmother. His father became ill with
a progressive dementia when Mr. Jones was eight
years of age, with a corresponding reduction in
parental discipline. Mr. Jones resented the family's
focus on his father's illness, and began to behave
disrespectfully and abusively toward his father. He
became exceptionally self-focused and developed a
sense of entitlement in relation to his overindulgent
mother and ineffectual father. He developed the
capacity to lie and manipulate his mother in order to
get what he wanted. He is described as having poor
impulse control, poor ability to delay gratification,
and deficits in social skills appropriate for his age,
including a lack of empathy for others. His father
died when Mr. Jones was 18 years old, and he
continues to experience feelings of guilt, shame and
anger in relation to his behavior with his father.
Mr. Jones has described himself as a slow
learner who preferred to stay home rather than attend
school. He was severely teased by his peers
regarding his small stature, eczema and chronic
asthma. He was also ashamed of his father's
condition. He was not accepted by his peers, leading
to a self-perception of social inadequacy and
corresponding feelings of anxiety and rejection. He
developed maladaptive strategies to attempt to align
himself socially, such as telling exaggerated stories
and engaging in farcical behavior, but such attempts
ultimately served only to compound his rejection and
isolation. Mr. Jones began to withdraw socially and
ruminate over others' responses, leading to anger and
resentment. These ruminations would escalate his
anger to the point that he would sometimes act out on
more physically and emotionally vulnerable peers.


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During this period of adolescence he also
appears to have developed a pattern of alleviating his
emotional distress through compulsive sexual self-
stimulation and fantasy relating to themes of
aggression and dominance. Such sexual stimulation
would strongly reinforce fantasies of dominance over
others as a way of defending against his feelings of
rejection and inadequacy, while simultaneously
sexualizing his violent impulses. This repeated early
pairing of sexual and aggressive, retributional drives
represents one of the primary risk factors in Mr.
Jones' sexual offending.
Mr. Jones left school at age 16 to join the
workforce, but he demonstrated an unstable work
history. He has reported difficulty interacting
effectively with adults, but another factor in his
employment problems was his sense of entitlement,
such that he did not like to be told what to do. Such
an attitude, if not substantially modified, will also
serve as a significant barrier to treatment aimed at
reducing his risk of reoffending.
Mr. Jones continued to experience
difficulties developing and maintaining satisfactory
adult relationships, resulting in subjective distress
and feelings of isolation. He utilized his previous
pattern of sexual preoccupation to mediate stress and
regulate his affect. Fantasies of control and
dominance served to soothe his sense of inadequacy
while expressing his anger and resentment over the
perceived rejections of others. These behaviors
manifest Mr. Jones' sexualized fantasies of
dominance, control and aggression, which serve to
facilitate temporarily reinforcing feelings of power
and efficacy that he otherwise lacks. In the absence
of more appropriate relationships with others through
which to gain these positive subjective feelings about
himself, he is likely to continue to fall back on these
behaviors, which will in turn reinforce and escalate
his risk. This suggests that a potentially effective
treatment variable will be to provide Mr. Jones with
more appropriate experiences in his relationships
with others.
In summary, his early life experiences
included rejection and ridicule by his peers,
combined with an overindulgence by his mother and
ineffectual discipline related to his progressively
disabled father. These conditions lead to the
development of a profound sense of inadequacy and
anxiety, social incompetence and isolation, along
with a sense of entitlement and the use of
manipulation and lying to get his way within the
family. Although he had a strong desire to connect
interpersonally with others, he did not develop the
social skills or interpersonal sensitivity to achieve


lasting relationships. When his dependency needs
were not met and he experienced instead the teasing
and ridicule of his peers, he began to comfort himself
through sexual stimulation, with fantasies of control,
aggression and retribution. His offending resulted
from a highly sexualized ideation of others,
particularly physically and emotionally less mature
males with whom he could act out the deviant sexual
fantasies that boosted his sense of efficacy and
power.
On the STATIC-99, Mr. Jones scored in the
high range of risk for sexual reoffending, based on
his prior sexual offences, his choice of unrelated,
male strangers as victims, and his lack of long-term
intimate adult relationships. Large samples of other
sexual offenders scoring in this range on the
STATIC-99 have shown sexual recidivism rates of
39% at five years, 45% at ten years, and 52% at
fifteen years following release to the community.
Results on the PCL-R indicate that although
Mr. Jones demonstrates moderately high levels of
psychopathic traits, he does not meet the criteria to be
classified as a severe psychopath, and therefore is not
a member of the subgroup of offenders with the
highest rates of sexual reoffending. However, his
characteristics of pathological lying, manipulation,
lack of remorse and empathy, impulsivity and
irresponsibility, make it more difficult for him to
conform to the expectations of a treatment program,
and to internalize and consistently utilize the gains he
has made in treatment.
Considering personality features more
broadly, results of a Million Clinical Multiaxial
Inventory (MCMI-III) provide a profile of emotional
and interpersonal functioning. On this measure he
displays prominent avoidant and self-defeating
personality features, marked by a significant level of
anxiety. Despite remarks regarding a sense of
entitlement presented in earlier reports, Mr. Jones had
a particularly low score on the scale measuring
narcissistic traits. It appears that Mr. Jones displays
entitlement stemming from his overindulgence as a
child and his limited capacity to recognize the impact
of his behavior on others or the consequences to
himself. Unlike the grandiose sense of self-worth
associated with narcissism, Mr. Jones in fact
struggles with a profound sense of overt inadequacy
and social incompetence, contributing to his anxiety
and occasional depression.
As a result of extensive inpatient treatment,
he appears to have a solid cognitive understanding of
his offence cycle, including the precursors and high
risk situations associated with his sexual offences.
The areas where he needs to demonstrate continuing


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progress involve applying the skills and insights that
he has learned in his current everyday interpersonal
relationships. He accurately identifies that he needs
to work on being consistently open and honest in his
dealing with others and eliminate his use of deceit,
manipulation, and secrecy, as these behaviors have
contributed to the development of situations in which
he has offended and interfered with his capacity to
benefit from interventions. However, his inability to
be consistent in his application of therapy and an
intermittent return to manipulative and dishonest
behavior have restricted the progress he has made in
treatment.
In light of his extensive treatment history, it
is anticipated that little more is to be gained from
additional intensive residential treatment for his
sexual offending. He appears to have acquired, at a
cognitive level, an understanding of the precursors to
his offending and the factors associated with
increased risk of reoffending. He has been taught a
variety of cognitive and behavioral techniques for
managing this risk. These will not be enough. A key
factor in minimizing his risk will be the adequacy of
his close relationships with appropriate adult
partners. The distress, isolation and frustration that
have resulted from previous situations in which he
has failed to establish adequate relationships with
other adults have directly contributed to his sexual
offences. Therefore it is essential that he establish
and maintain a strong social network of individuals
familiar with his offence cycle who are actively
involved in his transition to a fulfilling and offence-
free life in the community.
Discussion of Mr. Jones. This case
represents a situation common to many correctional
settings. The offender does not manifest significant
Axis I psychopathology, but demonstrates important
Axis II characteristics, including features of
psychopathy. Largely because of these personality
features, extensive exposure to treatment focusing on
sexual offending has resulted in limited gains. The
challenge becomes one of balancing the long-term
process of internalizing the goals of treatment with
the necessary restrictions and external monitoring
required to keep others safe. Having accurate
understanding of the individual's personality features
and a broad sense of his needs for establishing a
satisfying life will most effectively guide the process
of his eventual reintegration into the community.
One issue highlighted by this case is the
potential benefit of a thorough case formulation for
providing specific treatment recommendations prior
to and following release. The limitations of
standardized cognitive-behavioral relapse prevention


treatment modalities have become apparent with Mr
Jones, and further treatment must take into account
his personality dynamics and his tendency to recreate
the dysfunctional dynamics of his early
developmental experiences. Without an awareness of
and a sensitivity to these intra-individual factors
(Douglas & Skeem, 2005), treatment staff are likely
to contribute to a repetition of the previously
ineffective process by responding in ways that elicit
his avoidant and self-defeating behaviors. Treatment
approaches that explicitly consider early
developmental experiences and repetitive
dysfunctional behavior patterns, such as Cognitive
Analytic Therapy (Ryle & Kerr, 2002), Dialectic
Behavior Therapy (Linehan, Cochran, & Kehrer,
2001), or schema-focused therapy (Young, 1999),
may be more effective with Mr. Jones.
Ultimately the Court must determine the
applicable threshold for risk that must be met in
making a decision regarding Mr. Jones' release to the
community. This may reflect the communities
perceived tolerance of risk in such cases, but is
usually only vaguely specified in the language of the
relevant laws. The role of the assessment expert is to
provide as precise and clear an understanding of the
risk presented by the individual, based on current
empirical research and an etiological explanatory
formulation of the case. In the case of Mr. Jones,
much will depend on a careful balance between a
strong therapeutic alliance with treatment staff
knowledgeable of his particular risk factors, and
effective external monitoring upon his release.
Conclusions
The aim of presenting the two cases
illustrating the role of case formulation in risk
assessment was to provide examples similar to those
commonly encountered in forensic clinical settings.
Several points are demonstrated. One is that a
thorough evaluation of risk must move beyond the
consideration of actuarial measures and dynamic risk
factors to incorporate an understanding of
developmental and personality factors. The inclusion
of such causal factors provides an enriched
etiological explanation of sexual offending in an
individual case. Furthermore, the development of
case formulations for risk assessment cannot be
completely separate from considerations of treatment.
In fact, risk assessment is most useful when it is
explicitly tied to risk management, including both
treatment and supervision needs.
Finally, the goals of risk management and
public protect are best served when rehabilitation
efforts focus on assisting the offender to develop as
free and fulfilling a life as he is able to achieve in


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light of his personal goals, strengths and deficits and
social ecology. This requires a careful balancing of
externally imposed restrictions on an individual with
opportunities to meet his basic human needs in an
effective and pro-social manner. The process of
arriving at an appropriate rehabilitation plan is best
guided by knowledge of the latest empirical research
on the association between risk factors and
recidivism, integrated with a clear understanding of
the needs and psychological functioning of the
individual concerned. In summary, case formulation
in the service of risk assessment combines
specialized knowledge of recently developed
measures for sexual offenders with traditional clinical
skills for understanding the individual. Neither
component can be neglected if we are to provide
assessments that contribute to both the well-being of
the individual as well as the protection of the public.


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Barbaree, H.E., Seto, M.C., Langton, C.M., & Peacock, E.J.
(2001). Evaluating the predictive accuracy of six risk
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Beech, A. R., & Ward, T. (2004). The integration of etiology and
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Craissati, J., & Beech, A. (2005). Risk prediction and failure in a
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Doren, D.M. (2004). Stability of the interpretative risk percentages
for the RRASOR and Static-99. Sexual Abuse: A
Journal of Research and Treatment, 16, 25- 36.

Douglas, K.S. & Skeem, J.L. (2005). Violence risk assessment:
Getting specific about being dynamic. Psychology,
Public Policy, and Law, 11, 347 -383.


Dvoskin, J.A. & Heilbrun, K. (2001). Risk assessment and release
decision-making: Toward resolving the great debate.
The Journal of the American Academy of Psychiatry
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Hildebrand, M, de Ruiter, C., & de Vogel, V. (2004). Psychopathy
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BEHAVIOR ANALYSIS AND CHILDHOOD CONDUCT PROBLEMS BACK TO THE
FUTURE: A REVIEW OF DERMOT O'REILLY'S CONDUCT DISORDERS AND
BEHAVIORAL PARENT TRAINING
Arlene Wallace, Ph.D., Ellwyn & Joseph Cautilli, Ph.D., St. Joseph's University , Department of Criminal Justice


About 20 years ago, Quay (1986) argued
that conducted disorder was associated with failure to
respond to treatment and poorer prognosis for adult
living than any other disorder except autism. While
these arguments were being made, behavioral
researchers were developing models of this type of
pathology (Patterson, 2002; Reid, Patterson &
Snyder, 2002) programs for treating such behavior in
schools (e.g., Ninness, Glenn, & Ellis, 1993; and for
comprehensive review of this research see Walker,
1997) and the home environment (Reid, Patterson &
Snyder, 2002). One approach that has consistently
shown to change the developmental course for
conduct disorder is behavioral parent training
(McMahon, & Wells, 1998).
Four decades of research have supported the
use of training parents in the use of reinforcement
and punishment procedures to change children with
conduct disorders behavior. This research has
consisted of single subject designs (reviewed by
Patterson 1979) and group designs (e.g., Patterson,
Chamberlain, & Reid, 1982; Walter & Gilmore,
1973). Multiple lines of research have shown that
behavioral parent training produces both immediate
and long-term outcomes (Bank, Marlowe, Reid,
Patterson, & Weinrott, 1991; Barkley, 1997;
Gallagher, 2003; McMahon & Wells, 1998; Webster-
Stratton, 1996; Webster-Stratton, Kolpacoff, &
Hollingsworth, 1988; Webster Stratton, Hollinsworth,
& Kolpacoff, 1989; Wells & Egan, 1988). Enter
Dermot O'Reilly's book Conduct Disorder and
Behavioral Parent Training (2005).
This book is one of those rare research-
based enterprises that attempts bridges the gap
between theory and practice. The focus of the book is
three- pronged: (1) O'Reilly begins with a section
which introduces the methodology applied behavioral
analysis followed by (2) the example case studies of
children with conduct problems used during his
research, and, (3) finally, the intervention strategy
which employs behavioral analysis and parental
training. Beginning in sound, research-based theory
regarding behavioral parent training, O'Reilly
synthesizes the literature regarding behavioral
parental training such that both the phenomenon of
the conduct disorder itself as well as the triadic
method of behavioral training is clearly outlined and


underscored. With this grounding, O'Reilly is
thorough in his study of the available literature and
does not attempt to recreate the wheel in his effort to
provide feasible alternative methods to an already
overloaded social work system.
Instead, this well written book draws on the
comprehensive and quality research that has already
been done and focuses his attention on developing a
method by which social workers can use this proven
method effectively in the field. To create a method
of application which is, though not necessarily easy
to implement or without pitfalls, effective in the
treatment of troubled children with conduct disorders.
The ability to come to the aid of troubled families is
the foundational principle for social work.
Effective treatment of conduct disorders is
an area of need at this time. In the justice system,
statistics indicate that nearly 30 percent of juvenile
delinquents exceed or far exceed the criteria for
conduct disorders. It is clear from these findings that
the only other disorder that matches the prevalence of
conduct disorder in explaining the problems of
societal violence amongst juveniles today is that of
oppositional defiant disorder.
Clearly, if an intervention could be regularly
implemented so that behaviors of children with
conduct disorder could be modified, problems among
youth could be greatly reduced. And O'Reilly's book
offers excellent examples of how to do just that.
Another consideration beyond delinquency
is that of medical costs. O'Reilly's book suggests that
it has been calculated that the medical costs alone of
children diagnosed with conduct disorder greatly
exceed that of other disorders.
In one sense, the theoretical and even
practical applications of behavioral parent training to
children with conduct disorders are not new. It is
clear to the science of social work that behavioral
parent training greatly assists troubled children, their
families, and their schools. In fact, in studies like
that done by Webster-Stratton and Hammond (1997),
when parental training programs are put to the test,
parental training routinely has the greatest positive
effect on reducing unwanted behaviors and
maximizing problem solving strategies.


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O'Reilly's book presents a brilliant and
effective model for the social worker by which
behavioral parent training can be feasibly
implemented in their case studies. Part one, in which
O'Reilly summarizes the literature and theoretical
markers of behavioral training, is useful as
background, then, but the true innovation of his work
lays in part two wherein he describes how behavioral
parent training can be effectively utilized, even by
social workers overloaded with cases and
administrative duties. Best of all, he provides
evidence of the efficacy of these methods with results
from his use of the methods in numerous case
studies.
One of the primary underlying assumptions
in the behavioral parent training model is that to
actively and effectively engage parents in changes
that must be implemented in their child's behavior as
well as teaching them methods by which they can
accomplish those modifications is the key to success.
O'Reilly (2005) employs this idea precisely,
presenting the social worker with simple techniques
to encourage and train the parent to monitor their
child through checklists and data collection and to
shift their thinking so that they have a new and more
positive perspective on their child (p. 90-91). These
methods do not add more to the already overwhelmed
social worker and instead acknowledge that the
parent is the true agent of change in the child's
potential for improvement.
Continuing with the awareness of the parent
as agent of change, O'Reilly (2005) outlines methods
by which the parents can be trained in the use of
simple yet effective parenting techniques such as
time outs (p.113). In O'Reilly's case study research,
this active parental participation combined with
intensive sessions where new parenting techniques
were taught led to significant reductions in the
numbers of negative behaviors observed by the
parent (O'Reilly, 2005, p. 114). On average, the
percentage of negative behaviors dropped 30 percent
by end of the trial.
O'Reilly defines the role of the therapist or
social worker as an important role model to the
parent for how to positively and effectively interact
with the child. As such, the social worker must enter
into sessions with the parent with the awareness that
they are the teacher of the parent (O'Reilly, 2005,
p.88). This too, demands that the social worker
assume a very active role in helping the family and
the troubled child.
What O'Reilly does not elucidate is how
role modeling should take place. It is beneficial to
remember that most often poor parenting is learned


behavior and the adult children of poor parents who
are currently parents have psychological and
emotional scars of their own. In order for the parent
to remain receptive to the new method of parenting,
s/he must feel supported and must feel that success is
within reach. With this in mind, the social worker
who is helping retrain a parent in session must
consciously approach the parent in the very same
way one would a troubled child. Breaking large
goals into small manageable steps that can be easily
implemented by the parent is an excellent strategy.
Another approach is to encourage the parent
to take small steps toward the ultimate goal in the
sense that the social worker creates mini-goals for the
parent, always encouraging the parent and noticing
what is changing. In times when behavior worsens,
which is not only possible but likely, according to
O'Reilly's trials, the parent must be encouraged with
reminders that the new parenting method does work
and that it will work for them if they remain
consistent and dedicated to change.
It is hard to find any areas where this book
could be improved. One possible area for a future
edition of this book would be to look at greater use of
behavioral parent training in a constructional
approach format (Schwartz & Goldiamond, 1975).
All too often parent training is used to simply manage
children's behavior without a focus on skill
development, especially skills that could change the
life course for children. Another area for future
exploration is recent research on functional analysis
in parent training and training parents to increase
their sensitivity to the function of children's behavior
(see Dunst & Kassow, 2004). Dunst, & Kassow,
(21' 4) conducted a meta-analysis and showed that
behaviorally based interventions are the most
effective and efficient procedures to increase this
type of sensitivity.
In conclusion, conduct disorders are of
major importance to society. The pessimism of
treatemtn for this population has been tempered by
40 years of effective behavioral programming
delivered by parents to these children. O'Reilly's
book is a much needed update of this area to
clinicians and graduate students alike. It would make
excellent supplemental reading in a graduate course
around behavior analysis and child development.
The application of behavioral analysis theory to
actual case studies gives social workers a working
model of how to effectively apply this proven
theoretical model to their own work in the field. The
use of reinforcement and punishment procedures can
have considerable efficacy in changing behavioral
problems and in socio-emotional outcomes (Dunst,


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2003; Dunst, Raab, Trivette, Parkey, Gatens, Wilson,
French, & Hamby, 2007).


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