1 A Randomized Trial Examining the Effects of Conjoint Behavioral Consultation in Rural Schools: Student Outcomes and the Mediating Role of the Teacher-Parent Relationship Susan M. Sheridan1 Amanda L. Witte1 Shannon R. Holmes1 Michael J. Coutts2 Amy L. Dent3 Gina M. Kunz1 ChaoRong Wu1 1 Nebraska Center for Research on Children, Youth, Families and Schools; University of Nebraska-Lincoln 2 Children's Hospital & Medical Center in Omaha 3 Harvard University Published 2017 Sheridan, S. M., Witte, A. L., Holmes, S. R., Coutts, M. J., Dent, A. L., Kunza, G. M., & Wu, C. (2017). A randomized trial examining the effects of conjoint behavioral consultation in rural schools: Student outcomes and the mediating role of the teacher-parent relationship. Journal of School Psychology, 61, 33-53. The research reported here was supported by the Institute of Education Sciences, U.S. Department of Education, through Grant R324A100115 to the University of Nebraska-Lincoln. The opinions expressed are those of the authors and do not represent views of the Institute or the U.S. Department of Education. Information on peer review process: https://www.elsevier.com/journals/journal-of-school- psychology/0022-4405/guide-for-authors 2 Abstract The results of a large-scale randomized controlled trial of Conjoint Behavioral Consultation (CBC) on student outcomes and teacher-parent relationships in rural schools are presented. CBC is an indirect service delivery model that addresses concerns shared by teachers and parents about students. In the present study, the intervention was aimed at promoting positive school- related social-behavioral skills and strengthening teacher-parent relationships in rural schools. Participants were 267 students in grades K-3, their parents, and 152 teachers in 45 Midwest rural schools. Results revealed that, on average, improvement among students whose parents and teachers experienced CBC significantly outpaced that of control students in their teacher- reported school problems and observational measures of their inappropriate (off-task and motor activity) and appropriate (on-task and social interactions) classroom behavior. In addition, teacher responses indicated significantly different rates of improvement in their relationship with parents in favor of the CBC group. Finally, the teacher-parent relationship was found to partially mediate effects of CBC on several student outcomes. Unique contributions of this study, implications of findings for rural students, study limitations and suggestions for future research are discussed. 3 A Randomized Trial Examining the Effects of Conjoint Behavioral Consultation in Rural Schools: Student Outcomes and the Mediating Role of the Teacher-Parent Relationship Symptoms associated with behavioral and social-emotional challenges in our nation’s youth are among the most commonly identified reasons for mental health referrals (Stephan & Connors, 2013). Left untreated, disorders associated with behavioral and social-emotional difficulties can profoundly influence academic achievement, social relationships, and outcomes later in life (Bradshaw, Schaeffer, Petras & Ialongo, 2010). The presence of social-emotional and behavioral challenges, especially excesses in negative behavioral patterns, are related to poor academic performance (Lane, Barton-Arwood, Nelson, & Wehby, 2008; Reid, Gonzalez, Nordness, Trout, & Epstein, 2004), and predictive of later school drop-out, failure to attend college, and socioeconomic disparities during adulthood (McLeod & Kaiser, 2004). Taken together, the pervasive negative effects of behavior problems on children’s academic achievement appear to persist from early childhood through adolescence and beyond (Masten et al., 2005; Reinke, Herman, Petras, & Ialongo, 2008). Conversely, behavioral and social-emotional competence in the early school years – reflected in sustained attention, self-regulatory skills, and prosocial responses – is predictive of academic success. These foundational skills enable young students to adaptively engage in academic environments and appropriately respond to teacher instruction; thus, they are widely considered precursors to achievement (DiPerna & Elliott, 2002; Kwon, Kim & Sheridan, 2012). Based on laboratory tasks (McClelland et al., 2007) and teacher reports (McClelland & Morrison, 2003), learning behaviors contribute to a range of children’s academic skills, including literacy and math, at the beginning of kindergarten (McClelland & Morrison, 2003). 4 The Importance of Context Children’s behavioral, social-emotional, and academic skills are strongly influenced by context. Academic and social-emotional skills are the cumulative product of experiences within multiple overlapping ecologies, including communities (Miller & Votruba-Drzal, 2013), schools (Connor et al., 2014; Ponitz, Rimm-Kaufman, Grimm, & Curby, 2009), homes (Baker, Mackler, Sonnenschein, & Serpell, 2001; Dearing, McCartney, Weiss, Kreider & Simpkins, 2004), and interactions among them (Barbarin, Downer, Odom, & Head, 2010; Crosnoe, Leventhal, Wirth, Pierce, & Pianta, 2010). Whereas the direct effects of school and home environments on learning and behavior are often recognized, less empirical attention has been afforded to the role of geographic and community contexts on student outcomes. However, community context clearly contributes to differential student experiences and social-behavioral outcomes. In a recent study of a large, nationally representative sample, Sheridan, Koziol, Clarke, Rispoli, and Coutts (2014) found that rural children experienced greater difficulties with externalizing behaviors than children in cities and towns. Findings such as these are increasingly urgent given that one-third of U.S. schools are located in rural communities and 20% of our nation’s children – nearly 10 million – are educated in rural schools (Johnson, Showalter, Klein, & Lester, 2014). By definition, rural communities are small and geographically isolated, have small population bases, and experience limited revenue, which limits availability of and access to specialized services and ongoing support (Fortney, Owen, & Clothier, 1999; Monk, 2007). Lack of anonymity and trust (Hartley, Korsen, Bird et al., 1998; Owens, Richerson, Murphy, Jagelewski, & Rossi, 2007) along with fear of disclosure and stigmatization (Susman, Crabtree, & Essink, 1995) have been identified as psychological barriers within rural communities, leading 5 to under-identification of problems and failure to seek help (Girio-Herrera, Owens, & Langberg, 2013). Given that child and youth services suffer in low-density areas (Hodgkinson, 2003), rural communities often depend on schools to serve many functions beyond their primary mission of education (NEA, 2008). Rural schools have a below-average share of highly trained teachers to serve students with emotional and/or behavior disorders, and they struggle to provide specialized services (Monk, 2007). Although rural schools generally have small class sizes, this potential benefit is attenuated by teachers with fewer credentials and resources, lower salaries, and limited opportunities for professional development, all of which contribute to challenges in teacher recruitment and retention (Monk, 2007; Roscigno & Crowley, 2001). Most rural teachers indicate that supporting children’s behavioral and mental health are part of their role but feel unprepared to meet the educational needs of students with behavioral problems (Roeser & Midgley, 1997). Perhaps due to the perception that students in rural communities are better protected from mental health problems than their peers in urban communities, services to address problems are often poorly developed, ineffective, or fragmented (Moore, 2001). Whereas some studies have found positive benefits of behavioral interventions based on family-school partnerships (e.g., daily report card intervention, biweekly consultation meetings, and behavioral parenting sessions; Owens, Murphy, Richerson, Girio, & Himawan, 2008) on disruptive student behavior (e.g., hyperactivity, impulsivity, and conduct disorder symptoms) in rural schools, there remains a need for rigorous intervention research that identifies evidence-based social-behavioral interventions for students through partnerships in the rural context. Relationships and Partnerships between Families and Schools 6 Positive, constructive relationships between teachers and parents represent a potential opportunity to augment support services for rural students and families, and are increasingly recognized as a unique context supporting learning and development. This concomitant focus on relationships between families and schools embedded within the broader community context (i.e., exosystem) as the foundation for healthy development is grounded in ecological-systems theory (Bronfenbrenner, 1979, 1992). Accordingly, children develop within both immediate (i.e., microsystems) and distal (i.e., exosystem) contexts, and development is optimal when effective relationships and continuities (i.e., mesosystems) are strengthened. Empirical evidence supports that teacher-parent relationships, defined as each person’s perception of the affective quality of the home-school connection (Vickers & Minke, 1995), are critical to children’s academic achievement and social-behavioral functioning. The quality of relationships between teachers and parents has been found to explain both the association between children’s background characteristics (e.g., gender, race/ethnicity) and both their engagement in the classroom (Hughes & Kwok, 2007), and the benefits of parents’ motivational beliefs (e.g., parental self-efficacy and role construction) on children’s adaptive functioning and externalizing problems (Kim, Sheridan, Kwon, & Koziol, 2013). Importantly, addressing student problems without high quality teacher- parent relationships reduces the capacity to intervene in ways that fully promote children’s social and behavioral competence (Garbacz, Sheridan, Koziol, Kwon, & Holmes, 2015). The quality of the teacher-parent relationship appears to be particularly salient for interventions aimed at building partnerships between families and schools (Sheridan, Bovaird, Glover, Garbacz, Witte, & Kwon, 2012). Family-school partnerships extend beyond individual relationships to emphasize the bidirectional interactions between families and schools intended to enrich student outcomes through coordinated and consistent cross-system supports (Albright 7 & Weissberg, 2010; Downer & Myers, 2010; Lines, Miller, & Arthur-Stanley, 2010). Converging theoretical accounts and empirical evidence strongly suggest that family-school partnerships are important for optimizing students’ outcomes and may be particularly beneficial for rural students at risk of developing behavioral problems. Strategies to engage families and schools to work together in support of children’s development and learning have been associated with positive academic (e.g., improvements in standardized test scores and homework completion) and behavioral (e.g., reductions in disruptive behaviors and fewer school-related disciplinary actions) outcomes (for review see Fan & Chen, 2001). Family-school partnership models have been found to augment students’ social and adaptive skills at school (Sheridan et al., 2012) and home (Sheridan, Ryoo, Garbacz, Kunz, & Chumney, 2013); enhance math and reading achievement (Galindo & Sheldon, 2012); improve standardized test scores (Sheldon, 2003); minimize grade retentions (Miedel & Reynolds, 1999); decrease disciplinary problems, detentions, and in-school suspensions (Epstein & Sheldon, 2002); and minimize school dropout (Barnard, 2004). Despite considerable support for the efficacy of family-school partnership models, the influence of the larger systems (i.e., exosystem) in which these models are embedded, such as geographic context, have not been sufficiently explored in previous research. Family-school partnerships may be especially important in rural schools. A supportive relationship among schools, families and communities has been identified as among the most important factors for rural school success (Barley & Beesley, 2007). In a study of rural African American youth, for example, maternal involvement in education was linked to students’ academic competence and mediated the relationship between low education or socioeconomic status and both students’ self-regulatory and academic skills (Brody, Stoneman, & Flor, 1995). However, quality relationships between home and school in rural settings and meaningful 8 involvement of rural family members in educational decision-making are often difficult to realize. Rural parents have been found to talk with their children about school programs, attend school meetings, and interact with teachers less frequently relative to their counterparts in suburban and urban schools (Prater, Bermudez, & Owens, 1997). Based on the National Household Education Surveys Program of 2007 (NCES, 2007), only 54% of rural parents reported being satisfied with the way school staff interacted with them. Compared to their urban counterparts, teachers of students with behavioral problems in rural communities reported significantly less positive relationships with parents (Witte & Sheridan, 2016). Rural schools that fail to form relationships or effectively partner with parents miss an important opportunity to utilize a highly-valued segment of the community when providing meaningful programs for their children (Holmes, Witte & Sheridan, in press). Family-school (i.e., conjoint) consultation is capable of both addressing disparities in services for rural children with behavioral challenges and forging the essential link between homes and schools. Conjoint Behavioral Consultation Conjoint Behavioral Consultation (CBC; Sheridan & Kratochwill, 2008; also known as Teachers and Parents as Partners; TAPP; Sheridan, 2014) is defined as “a strength-based, cross- system problem-solving and decision-making model wherein parents, teachers, and other caregivers or service providers work as partners and share responsibility for promoting positive and consistent outcomes related to a child’s academic, behavioral, and social-emotional development” (Sheridan & Kratochwill, 2008, p. 25). Based on its theory of change, CBC is expected to ameliorate problematic behaviors through a positive relationship between parents and teachers who work as partners in a structured, collaborative, data-based problem solving process. Through the process, evidence-based interventions are planned and implemented 9 consistently across home and school settings. In CBC, parents and teachers serve as joint consultees who mutually identify, define, analyze, and address student concerns with the support of a consultant (e.g., behavioral specialist, school psychologist). Experimental studies have found CBC to be effective for addressing academic performance deficits (Murray, Rabiner, Schulte, & Newitt, 2008; Power et al., 2012; Weiner, Sheridan, & Jenson, 1998), behavioral challenges (Mautone et al., 2012; Wilkinson, 2005), and social skills (Colton & Sheridan, 1998; Sheridan, Kratochwill, & Elliott, 1990) with high levels of acceptability among parents, teachers, and service providers (Freer & Watson, 1999; Sheridan & Steck, 1995). More recently, a randomized controlled trial (RCT) in urban/suburban communities documented the efficacy of CBC in reducing students’ behavioral problems at school (Sheridan et al., 2012) and home (Sheridan et al., 2013) with a sample of 207 students displaying disruptive behaviors. Sheridan et al. (2012) found that relative to a business as usual control condition, CBC produced significantly greater gains in students’ teacher-reported adaptive behaviors (p = .02, d = .39), teacher-reported social skills (p = .01, d = .47), and parent- reported social skills (p = .04, d = .42). Furthermore, significantly greater gains in the teacher- parent relationship were found for those who participated in CBC (p < .01, d = .47) and these gains partially mediated the effect of CBC on child behavior change (Sheridan et al., 2012). Similar gains were found at home, wherein children whose parents and teachers participated in CBC showed significantly greater decreases in arguing, defiance, noncompliance and tantrums than children who experienced business as usual (Sheridan et al., 2013). Despite decades of research demonstrating positive effects of CBC on children’s social- behavioral problems across school and home, to date no research has explored the effect of CBC within rural communities. Early behavioral challenges are more prominent among rural students 10 than their urban/suburban counterparts (Sheridan et al., 2014), yet few evidence-based interventions supporting families and schools in rural communities have been identified. However, rural communities present unique characteristics that may influence the adoption of family-school partnerships and problem-solving interventions that target social-behavioral problems. CBC builds the skills and capacities of caregivers and is thus capable of addressing resource limitations in rural schools. Moreover, the theory of change underlying the intervention emphasizes strengths of the mesosystem (i.e., relationships between homes/families and schools/educators) operationalized through collaborative processes structured to allow individualized planning that responds to unique student needs within rural settings. Whereas recent research (Owens et al., 2008) suggests promising results for treating disruptive behavior in rural schools using family-school consultation (Sheridan, Kratochwill & Bergan, 1996), quasi- experimental procedures coupled with limited attention to fidelity and cross-setting effects precludes strong statements of efficacy or causality. Purpose of Study and Research Questions The purpose of this study was to replicate Sheridan et al. (2012) by extending its empirical base to explore the impact of CBC in rural settings. Specifically, we aimed to determine how well CBC reduces school problems and promotes social-behavioral skills for students in rural elementary schools. We were also interested in determining the effect of CBC on the teacher-parent relationship and whether this relationship mediates the effect of CBC on student outcomes in rural schools. Secondarily, we assessed the acceptability of CBC among participating teachers in the rural communities this study sampled. Specific research questions were: