Using Reliable Change to Calculate Clinically Significant Progress in Children with EBD: A BHRS Program Evaluation.

Emotional and behavioral disorders (EBD), as defined by Cook, Gresham, Kern, Barreras, Thorton, and Crews (2008), refers "to the full spectrum of students with social, emotional, and behavioral problems that do and do not receive special education services" (p. 132). The problematic behaviors can be of an internalizing or an externalizing characteristic--with children experiencing bouts of mild or clinical depression, attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), oppositional defiant disorder (ODD), and even non-clinical externalizing behaviors--and, largely, educational programs of the past have been unsuccessful in helping these children thrive (Cook et al., 2008; Jull, 2008). Children with EBD often have behavioral problems that lead to marked impairments in the academic performance (Nordess, 2005). On average, children with EBD receive lower grades and fail more courses with a drop-out rate exceeding 50% (Sacks & Kern, 2008). As of 2009, it was reported that students with EBD comprise 8% of all students with disabilities and the numbers are continuing to rise. Cook and colleagues (2008) confirm and expand on this claim by reporting the children with EBD are at a greater risk for poor school adjustment, for engaging in delinquent behaviors, and for adult psychopathology. This often leads the family to seek mental health services in the community. Creating a more pleasant and successful academic career is important, as children with EBD experience less than desirable social and economic outcomes, higher rates of unemployment, criminality, substance abuse, and aberrant sexual behavior (Sacks & Kern, 2008). Often times, the mental health system and the school system engage in treatment programs for these students. In Pennsylvania, this is referred to as behavioral health rehabilitative services (BHRS). Behavior Analysis & Therapy Partners (BATP) is a for-profit behavioral health agency whose clinicians serve a highly diverse population with respect to age (pre-school to elderly), diagnoses, presenting problems, and socio-economic status, including those with EBD. Depending on assignment, its BHRS division delivers treatment to children, many of whom have EBD, in the home, community, and/or school system. The BHRS are administered through a behavioral consulting process in which a behavioral specialist consultant (BSC) works with a consultee (parent, teacher, or other socializing agent) to provide services to advance a formal problem-solving model that uses applied behavior analysis (ABA) intervention specification within a targeted behavior-ecology context (Bergan & Kratchowill, 1990). The BSC helps the child indirectly by affecting the consultee. Conversely, BATP offers the services of a mobile therapist (MT) and/or a therapeutic staff support (TSS) intervene in the child's environment directly. According to Cautilli, Rosenwasser, and Clarke (2000), the MT affects behavior change by using behavioral therapy with both the individual child and the family while the TSS is a direct-care staff person who affects behavior change by providing proactive behavioral management and emotional support to the child. Both the TSS and the MT follow the treatment plan written by the BSC. BATP, like all BHRS, takes a family-focused approach in which both the families of the children and the children themselves are considered partners and experts with regards to the development and evaluation of services (Andersen-Butcher & Ashton, 2004). For BATP, this means the implementation of a parent training model and a use of siblings in the treatment, and the conjoing collaboration of the family, child, and treatment team on goal-setting. Rosen, Heckman, Carro, and Burchard (1994) found that youths who receive wraparound services appear to be satisfied with the services and are less likely to act out when they feel involved and feel that their contingency-oriented care is unconditional. …