(PS6-24) School-based Behavioral Health Treatment Format and Practice Patterns for Elementary School Students with Disruptive Behaviors

Childhood disruptive behavior problems, characterized by anger outbursts, aggression, and oppositional and defiant behaviors, are among the most common reasons for youth mental health service referral (Sukhodolsky et al., 2016). A recent Evidence Base Update by Kaminski & Claussen (2017) determined that two treatment families, group parent behavior therapy and individual parent behavior therapy with child participation, met criteria for the highest “well-established treatment” category for childhood disruptive behavior, implicating a focus on parents as key to intervention for youth 12 years of age or younger. Hawaii’s Department of Education (DOE) School-Based Behavioral Health (SBBH) program recently implemented an electronic health record (EHR) system in which therapists record intervention details, including service format (e.g., individual, parent, in-class), targets of treatment (TTs), and corresponding therapeutic practice elements (PEs). Preliminary analyses of this data suggest approximately 1% of services were delivered in a parent-focused format, implying that few students who exhibit disruptive behaviors are receiving evidence-supported parent-focused intervention. The primary aim of this study is to identify and describe current school-based therapeutic practice patterns when addressing childhood disruptive behavior.

Clinical data for all youth who received SBBH services in Hawaii’s Department of Education system from January 2023 to January 2024 were analyzed. 1,392 elementary school students received 10,419 service encounters in which a disruptive behavior TT (i.e., anger, aggression, oppositional/non-compliant behavior, willful misconduct) was endorsed as the primary target. Among these sessions, 46.7% (n=4862) were conducted individually, while 0.4% (n=38) were conducted with parents. An additional 15.4% (n=1600) were conducted in-class, 12.7% (n=1327) were consultation sessions, 12.2% (n=1267) were youth group sessions, 7.2% (n=751) were crisis intervention, 3.9% (n=406) were observations and 1.6% (n=168) were walk-in sessions. The ten most frequently endorsed PEs were Commands/Limit Setting (n=1194, 11.5%), Skill Building (n=647, 6.2%), Problem Solving (n=599, 5.7%), Cognitive/Coping (n=527, 5.1%), Natural and Logical Consequences (n=494, 4.7%), Line of Sight Supervision (n=490, 4.7%), Care Coordination (n=445, 4.3%), Self-Monitoring (n=406, 3.9%), Communication Skills (n=400, 3.8%), and Crisis Management (n=380, 3.6%).

Results suggest the plurality of elementary-aged youth treated for disruptive behavior problems received individual treatment, with some intervention focused on school staff consultation and in-class support but minimal intervention delivered with parents. Practices tended to focus on individual child skill development or enacting limits and negative consequences, with little focus on the adult-delivered reinforcement techniques (e.g., praise, rewards, differential reinforcement) characteristic of well-supported parent behavioral treatment. Implications of these findings will be discussed, including the potential for parent-focused intervention via school services and quality improvement options for SBBH staff training.