Chapter 3:
Responding to Children Exhibiting Early Warning Signs:
Early Intervention

With an effective foundation in place, most schools can look forward to a significant reduction in student behavioral problems. Preventing and greatly reducing such problems schoolwide makes it easier for staff to focus attention on specific students whose behaviors signal a need for early intervention. Students who continue to experience behavioral problems, despite schoolwide prevention activities, may be exhibiting early warning signs of violence.

This chapter focuses on the 10 to 15 percent of students whose problem behaviors indicate a need for early intervention. The chapter reviews the early warning signs of violence, lists effective practices used by a number of schools to teach individuals to recognize the early warning signs, outlines a process for receiving and responding to concerns about individual children, and discusses how to develop early individualized interventions.

Review of the Early Warning Signs of Violence

The list above  presents the early warning signs, which were introduced in the Early Warning Guide. Safe and effective schools ensure that teachers, administrators, school support staff, parents, students, and the larger school community become familiar with the early warning signs and the principles for taking appropriate actions. Understanding is the first step in the process of early intervention because it gives people the knowledge to recognize when a student may need help.

An important balance must be found between responding to the signs of a child who may need help and being harmful by labeling or overreacting to a situation. The ability to recognize the warning signs and to interpret them as indicators that a child may need assistance reduces the risk that parents, educators, and community members will misinterpret student behavior and react inappropriately.

This balance between responding and overreacting is more likely achieved when the efforts to identify and respond to students are guided by the five principles for using the early warning signs of violence, which are listed. Further elaboration on these five principles can be found in the Early Warning Guide.

Furthermore, the importance of building relationships with children and youth--part of the schoolwide foundation--cannot be overemphasized. When teachers, administrators, support staff, pupil services staff, and parents build close, caring, and supportive relationships with children and youth, they increase the likelihood that a child or youth who is in trouble will reach out to them (Hawkins, Doueck, & Lishner, 1988; Pianta, 1999). Teachers, due to their vast experiences with many same-age children, are uniquely positioned to identify students who may be exhibiting early warning signs. Teachers have frequent interactions and conversations with students, and are responsible for monitoring student academic performance and behavior. The depth and frequency of this contact often places teachers in a position in which students may disclose something personal or critically important to them, such as their feelings of isolation, reports of bullying behavior, situations of abuse or neglect, suicidal ideation, or threats that peers are making toward others or the school. Similarly, close and caring relationships between teachers and students can increase the chances that a student holding critical knowledge about another child or a potentially violent situation will disclose that information sooner rather than later. By getting to know children and youth, teachers, support staff, and parents are more likely to recognize a pattern or a change in behavior that may be an early warning sign and then seek assistance for the child.

Building the Capacity to Identify Early Warning Signs

Teachers, administrators, and support staff are bombarded each school year by in-service training and new initiatives. Information overload and time demands can be overwhelming. Yet, the responsibility to protect the safety of children and to meet the needs of children at risk for violence cannot be left to one person or group of people. Rather, all school staff must be familiar with the early warning signs and possess a sense of urgency to respond appropriately on the behalf of children. The following policies, procedures, and practices build the capacity of a school and community to identify the early warning signs exhibited by children:

• Policies that sanction and promote the identification of early warning signs and are backed by adequate resources. District and school policies should ensure that all members of the school community understand the importance of early warning signs and employ them appropriately. School boards and school-based policy-makers should be provided with evaluation data so that they can modify policies when necessary and allocate resources.

• Procedures that encourage and expect individuals to report concerns about a student exhibiting early warning signs. Each school should develop a procedure that students and staff can follow when reporting their concerns about a child who exhibits early warning signs. For example, in many schools the principal is the first point of contact. In cases that do not pose imminent danger, the principal contacts a qualified mental health professional (e.g., school psychologist) who takes responsibility for addressing the concern immediately. If the concern is determined to be significant, the child's family should be contacted. Parents are consulted before any formal assessments are implemented and are included in the development of interventions for their child. In cases where school-based contextual factors are determined to be causing or exacerbating the child's troubling behavior, the school acts quickly to modify them.

• Practices that encourage individuals to raise concerns about observed early warning signs and to report all observations of imminent danger immediately. When staff seek help for a troubled child, when friends report worries about a peer or friend, when parents raise concerns about their children's thoughts or behavior, children can get the help they need. School leaders can encourage members of the school community to raise concerns.

• Policies that support ongoing training and consultation. District and school policies should ensure that school staff receive training and consultation on the effective use of the warning signs.

• Policies and procedures that ensure that staff and students use the early warning signs only for preliminary identification and referral purposes. Only trained professionals should diagnose a student in consultation with the child's parents or guardians.

• School practices that encourage and provide opportunities for staff and families to establish close, caring, and supportive relationships with children and youth. Safe schools ensure that adults get to know children well enough to be aware of their needs, feelings, attitudes, and behavior patterns.

• Policies, practices, and procedures that foster collaboration between the school and the students' families. Working together, educators and parents are encouraged to review school records for patterns of behavior or sudden changes in behavior.

Connecting the Early Warning Signs to Early Intervention: Developing a Referral Response Process

Once school staff, parents, and community members become familiar with the warning signs and understand the urgency of being responsive to a child exhibiting signs, they need to know how to respond. They need to know with whom to share their concerns and how to get help. Teachers and staff should feel confident that when they share their concerns about a child, support will be readily available. They rely upon having quick access to trained professionals who will determine how to help these students.

In the majority of schools, a team of trained professionals already exists that provides consultation, evaluation, and intervention for students who are struggling academically, behaviorally, and socially. Safe schools will typically expand the focus of this team to include responding to individual students who exhibit early warning signs or, if necessary, create such a team. When a child or youth exhibits early warning signs, the school can no longer rely on schoolwide interventions alone. Rather, a Student Support Team, working with the teacher, child, and parents, must develop interventions that specifically address the child's behaviors of concern. Early intervention requires a referral process that can respond in a timely, coordinated, and effective manner.

Referral

It is important for all staff and families to understand the role and function of the Student Support Team and to be informed that the team is the authority to whom they bring their concerns regarding a child who may be exhibiting early warning signs. Staff training, parent question-and-answer sessions, classroom visits to inform students, and a public relations campaign within the community are needed to explain the team's membership, purpose, and approach and to disseminate information about how to request the team's assistance. Some schools create a brochure on ways to access the Student Support Team formally and include names and telephone numbers of team members to encourage informal consultations.

All those involved with the student--including administrators, teachers, support staff, families, and students--may find it difficult to admit that a child close to them needs help. To encourage people to share their concerns about individual children, the referral process must be easy, and it must result in immediate attention by the Student Support Team. Schoolwide referral systems should enable teachers, staff, and parents to access the Student Support Team in a timely, respectful, supportive, and confidential manner. A school should consider several principles when developing a referral process.

Involving Students in the Referral Process

Students must be partners in identifying early warning signs and providing information about potentially dangerous situations. Just as schools should make the referral process comfortable for adults, safe schools should tailor the referral process to the needs of students. Students who have information about a peer or a potentially dangerous situation may be fearful and hesitant to share their concerns. Both the Schoolwide Team and the Student Support Team should work with students to develop ideas and approaches for students to share their concerns about peers and situations without the fear of reprisal. Some schools have created a telephone hotline or a safe school box for written concerns; others have designated a set of students at each grade level who are "safe school liaisons," because they are available to hear concerns from their peers. Techniques like these enable students to share their concerns or information more comfortably, trusting that their information will remain confidential. Acknowledging to students that they are partners with the staff in keeping their school safe will create a sense of shared responsibility and ally students with the staff and community. Ensuring students of confidentiality will increase their use of the reporting system.

Responding to Referrals

The Student Support Team must have the capacity to respond to referrals in a timely, coordinated, and effective manner. Adopting a procedure to guide how the team provides individualized interventions and supports will improve both the efficiency and the effectiveness of the team's response to children and youth who need early intervention. Effective procedures incorporate problem-solving, consultation, preliminary planning, and developing and implementing interventions. Teams repeatedly cycle through these activities as they develop, implement, monitor, and modify individualized interventions and supports for particular students.

Safe schools understand that families are central to children's educational success and their social and emotional adjustment. To involve the family at each step--from referral through the implementation of individualized interventions--requires that families feel valued and supported and that they experience parity with other members of the team.

Families should be viewed as members of the team who can provide a comprehensive picture of their children from birth to the present. Families can help the team identify children's strengths and interests, as well as validate observed needs. The information provided by families informs decisions the Student Support Team will make with families regarding children's needs for individualized early intervention and assessment. Maintaining a collaborative relationship between the school and family will lay the groundwork for the successful implementation of early intervention plans.

The Initial Meeting

Once the Student Support Team receives a referral for a child who may be exhibiting early warning signs, the response process begins with a meeting. The agenda for the initial meeting will likely include problem-solving, consultation, and preliminary planning.

• Problem-Solving. The team should convene promptly to discuss the referral and to decide what actions to take following the meeting. The team's discussion in this meeting should focus on understanding the problem behaviors and events that led to the concerns and subsequent referral. Effective collaboration at this initial team meeting is imperative. Team members must encourage the referring person to discuss concerns openly and should acknowledge the person's "good work" in noticing the child's difficulties and making the referral for assistance. A team member should let the referring person know that questions will be posed to clarify the concerns and observations leading to the referral and to determine any immediate risks to the child or school community that should be addressed immediately.

• Consultation. Once the team discusses the questions, the team will determine how to respond to the concerns. At this stage, consultation with the referring teacher or parent may be appropriate. For example, the mental health professional or the school nurse may provide valuable support if the problem is social, emotional, or medical in nature. Similarly, the team may determine that the classroom teacher needs assistance from a master teacher to modify instructional approaches or classroom management strategies. If the team decides that a consultation will not be sufficient to deal effectively with the problem, it should decide how to proceed; sometimes, a more in-depth approach is needed.

• Preliminary Planning. At this point, the team develops a preliminary action plan to detail specific follow-up activities, outlining the child and teacher supports that will be implemented immediately and continue until the team meets again to develop the child's individualized intervention plan. The nature and complexity of the problem will determine how the team moves through the process.
  
  To ensure effective follow-through, the team may designate a case manager, who tracks every step of the process. In addition, the team should list the responsibilities of each team member on the action plan, list dates each activity will be completed, and agree on a date and time when members will reconvene. Typically, families and team members find that a case manager can facilitate progress and help families feel connected and in the "communication loop."

Developing Early Interventions

After the team's initial meeting, follow-up activities should focus on collecting data and information that identify the specific factors underlying and contributing to the problem behaviors. Several data collection procedures can help identify the causes of a child's problem behavior, but one approach--functional assessment--is becoming more familiar to school professionals. This familiarity is due to changes in special education law which require the use of functional assessment in particular situations involving students with disabilities.

The following describes how to employ functional assessment to develop individualized interventions and supports. The Student Support Team can use this process to develop individualized early interventions following the initial meeting to review and discuss the referral. There are three phases: problem identification and analysis, plan development and implementation, and plan evaluation.

Problem Identification and Analysis

• Understanding the Problem Behaviors. (Quinn, Gable, Rutherford, Nelson, & Howell, 1998) A well-developed assessment plan and a properly executed functional assessment should identify the contextual factors that contribute to behavior. This is accomplished by collecting information on the various conditions under which a student is most and least likely to be a successful learner. The information collected through discussion, record review and direct observation will allow the team to predict the circumstances under which the problem behavior is most and least likely to occur.

• Direct Measurement of the Problem Behavior. (Gable, Quinn, Rutherford, Howell, & Hoffman, 1998) During this stage, the Student Support Team collects and analyzes important information about the problem behavior. Observing the student in the classroom or other settings provides information regarding frequency, intensity, and severity of the problem; when and where the behavior does and does not occur, and the consequences of this behavior.

• Functional Assessment. Gable, Quinn, Rutherford, Howell, & Hoffman, 1998 During the problem-solving phase, the team identifies the causes of behavior and selects interventions to directly address those causes. In using functional assessment, the team looks beyond the behavior itself and focuses on the factors associated with the behavior in the setting in which it occurs. What is the child seeking to obtain, avoid, or escape? What does the child gain through this behavior? Conversely, what is the child protesting? The major objective is to substitute a positive behavior or response that serves the same function for the student, but is acceptable in the school. Since the child's desires are often intricately woven into the instructional setting and demands, functional assessment can provide information on ways to modify and address the instructional strategies and other environmental conditions contributing to the problem behavior.

Plan Development, Implementation, and Evaluation

• Developing a Step-by-Step Intervention Plan (Quinn, Gable, Rutherford, Nelson, Howell, & Hoffman, 1999).

  A plan should be developed to enable the child to substitute a replacement behavior and to make the environment and adult-child interactions conducive to the child's needs for support and learning. The new behavior should be meaningful to the child and allow the child to meet an appropriate need that the child was previously meeting by engaging in the undesirable behavior. Once the replacement behavior is defined, a plan should be developed to teach the child the new behavior and to change any environmental conditions that are either causing or maintaining the undesirable behavior.

• Implementing the Intervention (Quinn, Gable, Rutherford, Nelson, Howell, & Hoffman, 1999). Each step of the plan must be implemented as planned. If the plan is part of a child's IEP, it must be implemented as written. After two to four weeks, the team should gauge the preliminary success of the plan and identify ways the plan may be modified or supports added. If a school has tried other plans that lacked consistency or adequacy, the Student Support Team should allow more time to pass before determining the effectiveness of the new plan. Students can "wait out" an intervention if they expect it to discontinue quickly.

• Monitoring the Intervention (Quinn, Gable, Rutherford, Nelson, Howell, & Hoffman, 1999). If the plan is successful in meeting its intended goals, then the team must decide whether the intervention should be continued, scaled back, or applied to other behaviors or in other settings. Ultimately, the intervention should include a self-management and monitoring component so that the student can begin to take responsibility for his or her own behavior. If the plan does not meet its desired goals, then revisions to the intervention may be necessary. Revisions may also require the team to cycle back through direct measurement of behavior and functional assessment. If the student is a child with a disability, the requirements of the IDEA must be fulfilled.

Early Intervention Strategies

Below, is a list of strategies that may be used for early interventions. These strategies differ in their complexity. Although each strategy listed may work for some students, no one strategy works for all students. In addition, some strategies have been evaluated extensively through research studies, while others have less research to document their effectiveness. These strategies are provided to assist Student Support Teams who are developing intervention plans for students whose behavioral problems have been resistant to universal or schoolwide interventions. It is important to note that these strategies could also be integrated with the schoolwide foundation as well as incorporated in intensive interventions.

The references in the following list are designed to provide examples of resources for how to implement each strategy. The references are not intended to be exhaustive. In addition, schools and communities should take advantage of the following centers that can support their use of these strategies:

• Center for Effective Collaboration and Practice (CECP)
• Center for Mental Health in the Schools at UCLA
• Center on Positive Behavioral Interventions and Support (PBIS)
• Elementary and Middle Schools Technical Assistance Center (EMSTAC)
• National Association of School Psychologists (NASP)
• National Information Center for Children and Youth with Disabilities (NICHCY)

Early Intervention Strategies

(Intervention Strategy/Brief Descriptions)

Accommodations and modifications

Changing instructional practices, the ways students demonstrate mastery, and the way students input information to help students with disabilities or learning differences achieve and demonstrate academic mastery (e.g., oral responses versus written essays, tape recordings of text and information. (Benninghof, 1998; Deschenes, Ebling, & Sprague, 1994; Kameenui & Simmons, 1999; King-Sears, 1997; Lovitt & Horton, 1991; Phillips, 1993; Tomlinson,1999)

Alternative educational strategies

Alternative strategies provided for students who for some reason are not succeeding in the traditional setting. (Bear, 1998; Bear, Quinn, & Burkholder, in press; National Diffusion Network, 1995;  Project Forum, 1999; Quinn, Osher, & Valore, 1997; Quinn & Rutherford, 1998; Rutherford, R. B., & Quinn, 1999; Tobin & Sprague, 1999).

Alternative times--day and night school

Flexible schedules for students who, for various reasons, may not be able to attend school during traditional school hours.(O'Neil & Adamson, 1993 ; Quinn, Osher, & Valore, 1997; Tyler & Mira, 1993 ).

Anger management training

Methods for teaching socially appropriate ways to deal with anger. (Gibbs, Potter, Goldstein, & Brendtro, 1997; Goldstein & Glick, 1987; Goldstein, Palumbo, Striepling, & Voutsinas, 1995 ).

Behavioral intervention

A group of strategies designed to increase positive behaviors and decrease maladaptive behaviors by manipulating environmental conditions that either precede or follow the student's behavior.(Alberto, & Troutman, 1998; Meyer & Evans,1989; Rusch, Rose, & Greenwood, 1988; VanHouten & Axelrod, 1993; Walker, 1995; Wolery, Bailey, & Sugai, 1988).

Behavioral support plan

A plan designed to teach alternative replacement behaviors in environments and through adult interactions that are adapted and made more responsive to the student's individual needs. (Foster-Johnson & Dunlap, 1993; Horner, O’Neill, & Flannery, 1993; Quinn, Gable, Rutherford, Nelson, & Howell, 1998; Quinn, Gable, Rutherford, Nelson, Howell, & Hoffman, 1999; Sugai, Sprague, & Horner, 1999.)

Contingency contracting

A behavioral contract between a student and all involved adults. The contract specifies the expected behaviors and the consequences for performing or not performing them. (Friman, 1986; Forehand & McMahon, 1981; Greenwood, Hops, Delquardi, & Guild, 1974; Jenson, Rhode, & Reavis, 1995; Rhode, Jenson, & Reavis, 1996; Walker & Hops, 1973.)

Cognitive behavioral interventions and training

An approach to behavior change that includes changing the way a person thinks or feels about a situation. For example, teaching children that they have the problem-solving skills necessary to resolve social problems in a nonaggressive way will usually prevent them from dealing inappropriately with others in social situations (i.e., using aggression). (Braswell & Bloomquist, 1991; Kendall, 1991; Pressley, Woloshyn, & Associates, 1995; Smith, Siegel, O’Connor, & Thomas, 1994.)

Differential reinforcement

A method for decreasing inappropriate behaviors by rewarding alternative behaviors (e.g., decreasing out-of-seat behavior by rewarding the student for remaining in his or her seat; Deitz & Repp, 1983; Donnellan & LaVigna, 1986; Vollmer & Iwata, 1992.)

Drop-out prevention

Interventions designed to identify students at risk for dropping out of school and to provide them with the services and supports necessary to help them successfully complete school.  (Block-Pedego, 1990; Christenson, Sinclair, Lehr, & Hurley, 2000; Evelo, Sinclair, Hurley, Christenson, & Thurlow, 1996; Rossi, Ed., 1994; Sinclair, Christenson, Evelo, & Hurley, 1998; Thurlow, Christenson, Sinclair, & Evelo, 1997)

Drop-out reentry program

Interventions and transition planning to ensure a student's success when returning to school after dropping out.  (Chuang, 1992; Epstein, 1992;  Walker, 1995; Wolman, Bruininks, & Thurlow, 1989)

Environmental modifications

Modifying the class and school environment to respond to unique learning, behavioral, or emotional needs of students.  (Carta, Sainto, & Greenwood, 1988; Dadson & Horner, 1993; Kameenui & Darch, 1995; Murphy, 1983; Nordquist, Twardosz, & McEvoy, 1991; Sasso, Peck, & Garrison-Harrell, 1998)

Extended day programs

Structured after-school programs designed to offer student supervision. These programs can focus on athletics, academics, hobbies, or other interests.  (Hatkoff, 1994; Hellison, Martinek, & Cutforth, 1996; Mills & Cooke, 1983)

Extinction procedures

Ignoring a behavior that is reinforced by attention. For example, if a student talks out to get the teacher's attention, an extinction procedure would call for ignoring inappropriate talk-outs and reinforcing appropriate contributions to the group discussion (i.e., raising a hand and waiting for a turn to speak; Fagen, 1986; Lerman, & Iwata, 1995; Marable & Raimondi, 1995; Shukla & Albin, 1996)

Functional communication training

Teaching students alternative, adaptive ways to communicate their needs to others, such as through a brief verbalization, hand gesture, or signal (e.g., flipping a card over, which signals to the teacher the student's need for assistance; Durand, 1990; Durand & Carr, 1985; Myles & Simpson, 1994; Reichle & Wacker, 1993)

Goal-oriented therapeutic counseling

Services provided by trained school counselors, social workers, or psychologists to help a student or group of students address behaviors and personal or social problems.   (Pagliocca & Sandoval, 1995; Tharinger & Stafford, 1995; Wood & Long, 1991)

Group and family counseling

Counseling provided by a trained individual to help a person or persons work through a problem.  (Ehly & Dustin, 1989; Henggler, Schoenwald, Borduin, Rowland, & Cunningham, 1998; Singer & Powers, 1993; Vickers & Minke, 1997)

Mentoring

An individualized approach to providing a caring connection and a positive role model for a child. Mentors spend time with children, usually doing nonacademic-type tasks. (Schneider, 1995; Sinclair, Christenson, Evelo, & Hurley, 1998; Struchen & Porta, 1997; White-Hood, 1993.)

Positive behavioral interventions

Interventions designed to build on a student's strengths and increase the frequency of his or her adaptive responses while modifying the environment and adult responses to support the student's learning and use of adaptive responses.  (Bambura, Mitchell-Kvacky, & Iacobelli, 1994; Koegel, Koegel, & Dunlap, 1989; Neel, 1984; Sugai, Sprague, Horner, 1999)

Response cost

Taking away something positive for inappropriate behavior. Staying in during recess to complete a missed homework assignment is an example of response cost. (McCain & Kelley, 1994; Proctor & Morgan, 1991; Reynolds & Kelley, 1997; Walker, 1983; Witt & Elliott, 1982.)

Reward system

Rewarding students for appropriate behavior. Rewards can be social (a smile), an activity (time to read a novel), or tangible (candy or points on a token system). Students can earn rewards for themselves or for a group, and the rewards can be delivered by an adult, peer, or others.  (Adams, 1981; Darveaux, 1984; Fishbein & Wasik, 1981; Mason, McGee, Farmer-Dougan, & Risley, 1989; Tingstrom, 1994.)

Self-management

Teaching students to be aware of their behavior in such a way that they are able to identify its occurrence or nonoccurrence, measure its occurrence, and evaluate whether the behavior is improving, remaining the same, or getting worse. (Alber, Heward, & Hippler, 1999; Dunlapet al., 1995; Lam, Cole, Shapiro, & Bambara, 1994; McDougall & Brady, 1998; Reid & Harris, 1993; Sexton, Harris, & Graham, 1998.)

Shadowing older students

A plan where a student shadows a more senior student. Learning through modeling is often effective for transitions from one school to another.  (Cochran, Feng, Cartledge, & Hamilton, 1993; Elbaum, Vaugn, Hughes, & Watson Moody, 1999; Fuchs, Fuchs, Mathes, & Simmons, 1997; Hogan & Prater, 1993.)

Social problem-solving instruction

Teaching students to use an effective process to solve social problems fairly and without aggression. (Elias & Clabby, 1992; Elias et al., 1997; Gumpel & Frank, 1999; Jones, Sheridan, & Binns, 1993; Olexa & Forman, 1984.)

Time-away

Giving the student permission to briefly leave a learning activity or take a break. This is a coping strategy reinforced and encouraged by the teacher. (Nelson, 1997; McCullough, Huntsinger & Nay, 1977)

Time-out

Removing the student from a situation that is rewarding inappropriate behavior. For example, if a student's anger seems to be fueled by the cheers of his or her peers, the adult may ask the student to go to a place where peer attention is not available. (Erford, 1991; Nelson & Rutherford, 1983; Walker, 1995; Wolery, Bailey, & Sugai, 1988)

Token economies

A system by which students earn points (tokens) for appropriate behavior. Points can later be exchanged for reinforcement (social rewards, activities, or something more tangible; Anderson & Katsiyannis, 1997; Drabman & Tucker, 1974; Lyon & Lagarde, 1997; Myles, 1992; Naughton & McLaughlin, 1995)

Transition programs

Interventions specifically designed to identify transition needs, teach skills, and provide the support necessary for a child's success in a new environment; Clark, 1998; George, Valore, Varisco, Quinn, 1997; Patton & Blalock, 1996; Rosenkoetter, Hains, & Fowler, 1994)

Tutoring

Intensive academic instruction provided by a teacher or other skilled person; Delquardi, Greenwood, Whorton, Carta, & Hall, 1986; DuPaul & Henningson, 1993; Enright & Axelrod, 1995; Topping, & Ehly, 1998)

There are three keys to designing early interventions for particular students. The first is to assess (as completely as possible) the reasons for the child's behavior so that selection of strategies is highly informed and targeted. The second key is to match the intensity of the intervention to the severity of the need. The third key is to look at the student's strengths and interests, including his or her cultural background. Effective interventions should be culturally appropriate.

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