A Multidimensional, Multi-tiered System of Supports Model to Promote School Attendance and Address School Absenteeism.

School attendance and school completion are important benchmarks of successful development. Unfortunately, school absenteeism and school dropout remain debilitating and prevalent conditions among youth. Stakeholders invested in promoting school attendance and reducing school absenteeism generally agree that multifaceted ecological frameworks are needed to account for these heterogeneous problems as well as differences across local education agencies and broader jurisdictions. A multi-tiered system of supports (MTSS) framework emphasizes many aspects that match well with school attendance and its problems, including prevention and a continuum of supports, screening, evidence-based assessment and intervention, problem-solving and data-based decision-making, implementation fidelity, and natural embedding into extant school improvement plans. This article outlines a multidimensional MTSS model for school attendance and absenteeism to account for recent developments regarding service delivery within schools. Such developments include integrated models of multi-tiered service delivery to concurrently address multiple domains of functioning, the development of more nuanced approaches for students with various challenges, and consideration of three-dimensional (pyramidal) perspectives to allow simultaneous and yet nuanced strategies for several domain clusters. Sample domain clusters common to the literature that could populate the multiple dimensions or sides of a MTSS pyramid model for school attendance and absenteeism are presented. These domain clusters include (1) school refusal/truancy/school withdrawal/school exclusion, (2) functional profiles and analysis, (3) preschool/elementary/middle/high school, (4) ecological levels of impact on school attendance and its problems, and (5) low/moderate/high absenteeism severity. Recommendations are made as well regarding broader MTSS integration and implementation science vis-à-vis school attendance and its problems.

Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 2).

As noted in Part 1 of this two-part review, school attendance is an important foundational competency for children and adolescents, and school absenteeism has been linked to myriad short- and long-term negative consequences, even into adulthood. Categorical and dimensional approaches for this population have been developed. This article (Part 2 of a two-part review) discusses compatibilities of categorical and dimensional approaches for school attendance and school absenteeism and how these approaches can inform one another. The article also poses a multidimensional multi-tiered system of supports pyramid model as a mechanism for reconciling these approaches, promoting school attendance (and/or prevention of school absenteeism), establishing early warning systems for nimble response to school attendance problems, assisting with global policy review and dissemination and implementation, and adapting to future changes in education and technology.

Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 1).

School attendance is an important foundational competency for children and adolescents, and school absenteeism has been linked to myriad short- and long-term negative consequences, even into adulthood. Many efforts have been made to conceptualize and address this population across various categories and dimensions of functioning and across multiple disciplines, resulting in both a rich literature base and a splintered view regarding this population. This article (Part 1 of 2) reviews and critiques key categorical and dimensional approaches to conceptualizing school attendance and school absenteeism, with an eye toward reconciling these approaches (Part 2 of 2) to develop a roadmap for preventative and intervention strategies, early warning systems and nimble response, global policy review, dissemination and implementation, and adaptations to future changes in education and technology. This article sets the stage for a discussion of a multidimensional, multi-tiered system of supports pyramid model as a heuristic framework for conceptualizing the manifold aspects of school attendance and school absenteeism.

Sluggish vagal brake reactivity to physical exercise challenge in children with selective mutism.

Cardiovascular response patterns to laboratory-based social and physical exercise challenges were evaluated in 69 children and adolescents, 20 with selective mutism (SM), to identify possible neurophysiological mechanisms that may mediate the behavioral features of SM. Results suggest that SM is associated with a dampened response of the vagal brake to physical exercise that is manifested as reduced reactivity in heart rate and respiration. Polyvagal theory proposes that the regulation of the vagal brake is a neurophysiological component of an integrated social engagement system that includes the neural regulation of the laryngeal and pharyngeal muscles. Within this theoretical framework, sluggish vagal brake reactivity may parallel an inability to recruit efficiently the structures involved in speech. Thus, the findings suggest that dampened autonomic reactivity during mobilization behaviors may be a biomarker of SM that can be assessed independent of the social stimuli that elicit mutism.

Teacher key opinion leaders and mental health consultation in low-income urban schools.

Diffusion theory posits that information is disseminated throughout a social network by the persuasion of key opinion leaders (KOLs). This study examined the relative and combined influence of peer-identified KOL teachers (n = 12) and mental health providers (n = 21) on classroom teachers' (n = 61) self-reported use of commonly recommended classroom practices for children with attention-deficit/hyperactivity disorder in 6 low-income urban African American communities, relative to teachers (n = 54) at 4 matched schools who received mental health provider consultation only. Mixed-effects regression models showed that KOLs in collaboration with mental health providers promoted higher rates of teachers' self-reported use of recommended strategies than mental health providers alone, and that these effects were mediated by KOL support but not by mental health provider support. The results suggest an expanded role for KOL teachers as indigenous and natural supports for the dissemination and implementation of school-based mental health programs.

School-based mental health services for children living in high poverty urban communities.

Studied the effectiveness of a school-based mental health service model, PALS (Positive Attitudes toward Learning in School), focused on increasing initial and ongoing access to services, and promoting improved classroom and home behavior for children referred for Disruptive Behavior Disorder (DBD) from three high poverty urban elementary schools. Classrooms were randomly assigned to PALS or referral to a neighborhood mental health clinic, with children identified by teacher referral and follow-up parent andeher ratings. Results indicated significant service engagement and retention for PALS (n=60) versus families referred to clinic (n=30), with over 80% of PALS families retained in services for 12 months. PALS services were correlated with positive changes in children's behavior as rated by parents, and with improvements in children's academic performance as rated by teachers. Implications for the design and delivery of mental health services for children and families living in high-poverty urban communities are discussed.

Child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: development and preliminary results.

OBJECTIVE: To describe child- and family-focused cognitive-behavioral therapy (CFF-CBT), a new developmentally sensitive psychosocial intervention for pediatric bipolar disorder (PBD) that is intended for use along with medication. CFF-CBT integrates principles of family-focused therapy with those of CBT. The theoretical framework is based on (1). the specific problems of children and families coping with bipolar disorder, (2). a biological theory of excessive reactivity, and (3). the role of environmental stressors in outcome. CFF-CBT actively engages parents and children over 12 hour-long sessions. METHOD: An exploratory investigation was conducted to determine the feasibility of CFF-CBT. Participants included 34 patients with PBD (mean age 11.33 years, SD = 3.06) who were treated with CFF-CBT plus medication in a specialty clinic. Treatment integrity, adherence, and parent satisfaction were assessed. Symptom severity and functioning were evaluated before and after treatment using the severity scales of the Clinical Global Impression Scales for Bipolar Disorder (CGI-BP) and the Children's Global Assessment Scale (CGAS) respectively. RESULTS: On completion of therapy, patients with PBD showed significant reductions in severity scores on all CGI-BP scales and significantly higher CGAS scores compared to pretreatment results. High levels of treatment integrity, adherence, and satisfaction were achieved. CONCLUSIONS: CFF-CBT has a strong theoretical and conceptual foundation and represents a promising approach to the treatment of PBD. Preliminary results support the potential feasibility of the intervention.