This naturalistic study evaluated the treatment effectiveness of a U.S. New England region adolescent partial hospital program (PHP) for individuals referred from higher versus lower levels of care (LOC). Participants were adolescents ages 12 to 18 admitted to the in-person ( n = 161) and virtual ( n = 78) day programming. Chart review determined the referral source, and the Youth Outcomes Questionnaire (YOQ) assessed interpersonal relations (IR), intrapersonal distress (ID), suicidal ideation (SI), and self-injurious behavior (SIB) at the time of admission and discharge. Independent samples t -tests demonstrated the similarity of symptom severity at the time of admission for both higher and lower LOC, except for higher reports of SIB for higher LOC referrals to the virtual program. Repeated measures analyses of variance (ANOVAs) revealed improvement in all outcome measures and no significant difference in treatment effects or length of stay between higher versus lower LOC referrals. Study findings demonstrate the promise of PHPs to function effectively as both a step-up and step-down in the mental health continuum of care, reflect appropriate utilization of referrals to this LOC, and support the promise of telehealth as an alternative to in-person therapies.

Students identified with emotional and behavioral disorders (EBDs) often have difficulty with social adjustment and academic achievement, engaging in problem behaviors such as defiance, rule-breaking, and truancy, yet one particularly challenging behavior is aggression. Researchers assert that verbal aggression (VA) is the most frequent form of aggression in schools; however, little is known about student perceptions of VA among students with EBD. We surveyed 144 U.S. secondary students with EBD finding infrequent reporting to teachers about VA victimization. According to students, the most effective teacher responses to a report of VA victimization were moving the victim away from the perpetrator, providing advice, and punishing the aggressor. Students reported that the content of teacher instruction about VA most often included reporting victimization to a teacher, avoiding the aggressor, and ignoring the verbally aggressive behavior. We discuss implications for teacher education and practice including what strategies deter VA and effective teacher responses to victimization. We conclude with recommendations for future research such as examining risk and protective factors for VA involvement, assessing whether students’ attitudes and beliefs contribute to VA, and conducting longitudinal studies.

Teaching is one of the most stressful occupations in the United States. This is especially true for teachers who are responsible for meeting the complex needs of students with disabilities, particularly those with emotional and behavioral disorders (EBD). In fact, EBD teachers have a higher risk of experiencing burnout than their special education and general education colleagues. This burnout leads EBD teachers to leave the specialization of EBD, leave the field of special education, or leave the teaching profession as a whole. One way to mitigate this exodus of EBD teachers is to provide a broader pedagogical opportunity. Project-based learning (PBL) is a pedagogical methodology that is not often used by EBD teachers. The current study examines the use of PBL teaching to support students behaviorally and its impact on EBD teacher stress and job satisfaction. PBL was shown to improve student classroom and personal behaviors as well as increase job satisfaction for EBD teachers.

This study uses a novel measure to describe school refusal (SR) behavior among 91 U.S. adolescents ages 13 to 18 years old in the month leading up to a partial hospitalization program (PHP) admission. Youth exhibit a range of SR behaviors. Three fourths (77%) reported missing at least two full days of school and nearly one third (29%) reported being absent from school the entire month before PHP admission. Among youth who reported attending school, 36% reported leaving school early, 55% reported leaving the classroom, and 59% reported arriving late to school at least “a little” or 2 days in the month prior to PHP admission. Youth rarely shared that they spend time with friends or doing homework while absent from school. In addition, agreement between caregivers and youth on the extent to which youth are struggling with school attendance and how youth spend their time while out of school was low to moderate ( r = .14–.52). Results suggest that the School Interference Questionnaire (SIQ) can complement existing SR instruments to offer descriptive information about the frequency and type of SR behavior, perceived impact, and targets of intervention by identifying potential positive and negative reinforcers.

Rural schools experience difficulty in filling teaching positions at higher rates than non-rural schools. Recruiting and retaining teachers are critical in these districts; however, because the term “rural” is variable, a one-size-fits-all response is not possible. Rural communities tend to be geographically remote, have a low critical mass of students with distinct disabilities, and have relatively few resources to provide differential support for students. In this context, special educators may find themselves in circumstances where they operate as general specialists who are responsible for addressing a broad range of student needs without the support of other related service providers (e.g., school psychologists, curriculum specialists, school counselors, speech and language pathologists). Garwood’s article provides a catalyst to consider ecological system factors that affect burnout, attrition, and, as a consequence, instruction, particularly for students with disabilities. In this response, we view this issue from a perspective of rural schools, where the system contexts are varied and directly impact teacher-level variables, such as the ability to implement evidence-based practices (EBPs) with fidelity. Taking a developmental systems approach, we describe what makes rural settings unique and how these characteristics interact with the critical features of EBPs, as well as suggest how preparation and induction programs might better prepare and sustain teachers to adapt instruction to these rural contexts. We conclude with implications for practice and policy.

Disproportionality persists with regard to the labeling of students with emotional and behavioral disorders (EBD). A blending of critical race theory and disability studies, or DisCrit, provides a framework to examine disproportionality. In this article, a DisCrit mindset is applied to examine how racism and ableism intersect to disproportionately marginalize children of color. A critique of assessment practices, as well as the EBD definition, from a DisCrit perspective is offered to strengthen approaches for equity. We end with recommendations for educational practices and policies and suggest areas for future research.

Treatment foster care (TFC) provides critical mental health supports for youth with emotional, behavioral, and social difficulties who are at risk for adverse long-term outcomes. Existing evidence-based models of TFC are effective, yet resource-intensive, and they have relied primarily on evidence of implementation effectiveness with samples of non-minority parents. Recent research highlights the efficacy of an emerging, socially acceptable model that integrates existing evidence-based practices with usual care. This study applied the new model, Together Facing the Challenge (TFTC), within an urban TFC program. Trained TFC program staff delivered the TFTC training to foster parents in two cohorts. Foster parents reported child problem and prosocial behaviors pre-, mid-, and post-training, as well as 1, 3, and 12 months after the training. Results indicated that foster parents demonstrated an increase in knowledge of TFTC skills following the training and were satisfied with the training. Child problem behaviors significantly decreased over time. There were no significant changes in prosocial behavior over time. Implications of this study include the replication and extension of the use of TFTC, an evidence-based and resource-efficient intervention, to reduce problem behaviors of TFC children in urban settings.

The term level of care is utilized in mental health care to refer to the different ways in which treatment can be delivered, including qualitative (e.g., modality, approach, setting) and quantitative (e.g., number of sessions, frequency of sessions) variations in services. The concept is often embedded in models of care and measures, yet there is no agreed upon definition or understanding of what it encompasses. A scoping review of level of care conceptualizations in models of care, and triage and service use measures was conducted. Twenty-nine conceptualizations across 63 articles were identified, 12 focused on qualitative components, four on quantitative components, and 13 on a combination of qualitative and quantitative components. A conceptual model to integrate the literature reviewed is proposed.

This article critically discusses the ecology of public schools in the United States: systemic barriers and associated biases that permeate these learning contexts and derail efforts to close opportunity gaps for African American adolescents with emotional and behavioral challenges. Using results from a mixed-methods study, we illustrate the ubiquity of an a-developmental perspective that guides perceptions of what is needed to keep these students in and successful at school. A close examination of school mental health providers’ perceptions of what is important and feasible in public school contexts shows recommended interventions to be necessary but not sufficient. We highlight important considerations in the reframing of schools as a dynamic developmental system and conclude with recommendations about how to harness adolescents’ strengths to generate strategies that move us toward more equitable and socially just schooling.

Despite research on peer dynamics in mainstream classrooms and in mental health interventions, investigations of peer dynamics in self-contained classrooms for students with emotional and behavioral disorders (EBD) are limited. This study examined the influence of classroom behavior norms on individual behavior in a school for students with behavior challenges. Ratings of respectful behavior and rule-following behavior were collected for each marking period of one academic year during reading instruction and during lunch at both individual and classroom levels. Two sets of hierarchical linear models examined whether individual behavior trajectories were independent of classroom grouping (i.e., unconditional growth models) and whether classmate behavior norms predicted individual behavior (i.e., conditional growth models). Overall, individual trajectories for respectful behavior and rule-following behavior were not dependent on classroom groupings. However, across behaviors and settings, classroom norms significantly predicted individual behavior. These findings extend classroom norms research into an EBD setting and suggest that classroom norms may promote or inhibit positive behavior within self-contained classrooms for students with EBD. Behavior support programs within self-contained settings should account for influence of classroom norms (e.g., incorporation of group contingencies) to enhance social functioning of students with EBD.