Enhanced First Step to Success

Purpose & Background: The need for interventions that are effective with children who display severely challenging behavior is substantial. This presentation will focus on the results of an Institute of Education Sciences (IES) grant to bolster the First Step to Success program (Walker, et al. 1998). The program enhancements, designed to extend its applicability to students with severe behavior problems, include revisions to the home and class components; the enhancements were inspired by the theory and practices associated with applications of motivational interviewing in school based settings (Dishion & Stormshak, 2007; Miller and Rollnick's, 2002; Reinke, Lewis-Palmer, & Merrell, 2008). Consistent with the IES goal structure, the primary purpose was to develop a fully manualized intervention and measurement protocol, assess the social validity of the enhancement, and demonstrate the promise of the intervention in preparation for an efficacy trial. Methods: The iterative development process included several waves of revision following consultation with an advisory board; implementation; and analysis of screening, fidelity, process and outcome data. This presentation will highlight findings from the pilot phase, which involved implementing the initial version of the enhanced protocols via an open-case design (N = 9). Process data included measures of satisfaction, coach-parent alignment, and parental stress. Outcome measures, collected at baseline and posttest, consisted of teacher and parent reports of social skills and problem behaviors (Social Skills Improvement System rating scales (SSiS); Gresham & Elliott, 2008), and direct observation of children's academically engaged time and peer social interactions. Results: All children (100%) completed the school component eight parents (89%) completed the home component. Mean ratings across the 5-point parent satisfaction survey ranged from 4.4 to 4.8, with overall mean ratings of parent satisfaction of parents of children from self-contained (M = 4.6; SD = 0.5) and general education settings (4.8; SD = 0.3) were favorable. All seven respondents of the parent interviews identified benefits of the home services and more than half of the parents indicated that home activities were enjoyable and resulted in increased parent-child interaction. To examine responsiveness to the intervention we computed a reliable change index (RCI) to assess whether the change in functioning was statistically reliable (Jacobson & Truax, 1991). An RCI score was calculated for each student by computing the difference between observed baseline and post intervention scores and dividing by the standard error of measurement. Following the recommendations of Martinovich, Saunders, and Howard (1996), if an RCI score was greater than 1.96, the change was considered statistically reliable at p < .05. Using the RCI statistic 7 of 8 cases (87.5%) and 5 of 7 cases (71.4%) for which we had complete data demonstrated reliable changes based on teacher- and parent -reported social skills, respectively. Conclusions and Implications: Motivational interviewing is a promising approach to create new school-based interventions or enhanced existing ones. Our attempt to create an enhanced version of the First Step to Success intervention based on the principles of motivational interviewing was favorably reviewed by teachers and parents, and demonstrates promise as an effective practice.