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Teachers of Children With Emotional Disturbance: A National Look at Preparation, Teaching Conditions, and Practices

Posted on: Saturday, 14 January 2006, 03:03 CST

By Henderson, Kelly; Klein, Sheri; Gonzalez, Patricia; Bradley, Rene

ABSTRACT:

Maintaining an adequate supply of qualified special education personnel is a major challenge. In particular, serious shortages of teachers of children with emotional disturbance (ED) jeopardize delivery of appropriate special education and services to this population. This article reports data from the national Study of Personnel Needs in Special Education on the quality of personnel who teach children with ED. Teachers of children with ED are compared with other special education teachers in terms of experience, working conditions, credentials, preservice preparation, instructional skill, and future plans. Teachers of children with ED are less experienced and worked in more restrictive settings than their special education teacher colleagues. They were less credentialed and more likely to have been credentialed via alternate certification programs. Teachers of children with ED judged themselves to be more skilled in assessing and addressing behavior but less skilled in other instructional tasks.

Teachers of children and youth with emotional disturbance (ED)1 face enormous instructional and management challenges. They are among the most likely to leave the field. Workforce quality and quantity may be influenced by factors including state and local policies, working conditions, preservice education, and continuing professional development (Carlson, Lee, Schroll, Klein, & Willig, 2002). It appears that a confluence of these factors has resulted in a serious shortage of qualified ED personnel. Demand for teachers of children with ED greatly outweighs the supply, a problem due partly to high teacher attrition and partly to inadequate production of new teachers. A brief review of literature reveals much about the nature of the teacher shortage in special education, though relatively little is known about the specific factors affecting the recruitment and retention of teachers of children with ED or about their working conditions.

Teacher Shortage

The shortage of special education teachers, especially teachers of students with ED, is well documented, both at the national and state levels. Nationally, 98% of school districts report shortages of qualified special education teachers (Bergert & Burnette, 2001). Nearly 33,000 special education positions are filled by teachers who are not fully certified, and 4,000 positions remain vacant (U.S. Department of Education, OSEP, 2000). The American Association for Employment in Education (2001) cites special education and behavioral disorders as the teaching areas with the highest demand in the United States. Prior to 1996-1997-when collection of federal data on shortages and full certification of teachers of students with ED was discontinued-the teacher shortage in the area of emotional and behavioral disorders (EBD) nationally was particularly significant compared with other areas (Katsiyannis, Zhang, & Conroy, 2003). State reports confirm that in Wisconsin, the greatest shortage and the largest number of teachers employed on emergency licenses were in the area of ED (Lauritzen, 1999). Similarly, in Texas, most newly hired teachers on probationary certifications were in the area of secondary special education. Twenty-nine percent of new secondary special education teachers were hired with probationary certificates, more than twice the average rate (14%) of all teachers hired (Sparks, 2004).

Attrition

One factor that contributes to shortages of special education teachers is attrition, or those persons who leave the field of special education. State data again confirm the seriousness of the problem. One statewide study found a 13% annual attrition rate for teachers of children with EBD (Seery, 1990, cited in Center & Stevenson, 2001). The Texas State Board for Educator Certification (1998) found that half of novice teachers left teaching within five years. In every case, data from Kansas, Michigan, and Wisconsin indicate the attrition rate for teachers of children identified as ED/BD was higher than that for total special education teachers (range: 10%-16.3% versus 8%-14.1%) (Lauritzen & Friedman, 1991). Attrition for teachers on emergency licenses for ED/BD was even higher; much of this attrition was attributed to individuals who transferred to general education teaching positions as soon as they were certified (Lauritzen & Friedman, 1991).

Studies since the early 1990s have examined the factors that contribute to attrition and retention of special education teachers (Billingsley, 2004). While experience, age, and certification appear to be linked to special education teacher attrition, the impact of other personal factors, teacher qualifications, and aspects of work environment is less clear (Billingsley, 2004). Teachers' personal responses to the work environment, however, clearly do influence their attrition and intent to leave the field. For example, the largest portion of teachers who left special education reported dissatisfaction with their teaching positions-they felt unsupported, unprepared, overwhelmed by student needs or job responsibilities, disempowered, or all of these (Brownell, Smith, McNeIMs, & Miller, 1997). Fewer who left indicated they enjoyed teaching special education but left the classroom because of external factors such as other job opportunities, family influences, or certification issues.

Gersten and colleagues used path analysis to examine the relationship between teachers' intent to stay in special education and other factors (Gersten, Keating, Yovanoff, & Harniss, 2001). Among the factors with the strongest overall effect were building- level support from other teachers and principals, professional development opportunities, satisfaction with current assignment, and commitment to the profession. Factors negatively associated with intent to stay included role dissonance (i.e., the mismatch between special educators' beliefs about the role of a special educator and their actual day-to-day experiences) and stress due to job design.

Job-related stress appears to play a contributing role in influencing teachers of children with ED to leave the field. Cross and Billingsley (1994) found that teachers of students with ED reported higher levels of stress and greater role problems than other special educators. More recently, Center and colleagues found that teachers of children with EBD scored significantly higher on a measure of teacher stress than other special education teachers, and that those who reported more stress were more likely to want to leave the position of teaching children with EBD (Center & Callaway, 1999; Center & Stevenson, 2001).

Preparing New Teachers

The other major factor affecting the shortage derives from the number of teachers prepared to teach children with ED each year. Assuming a steady supply of children with ED in need of services, if the number of teachers prepared matched or exceeded the number leaving the profession, the overall supply of teachers would be adequate (although district-specific shortages might still exist). However, this is not the case. At the state level, Wisconsin, for example, reported that between 1979 and 1990, the number of state certifications issued to teach in ED/BD programs remained relatively constant, while the number of students with ED/BD served steadily increased (Lauritzen & Friedman, 1991). Nationally, between 1992- 1993 and 1998-1999, the number of children with disabilities grew from 5.08 million to 6.11 million, an increase of 20.3%. Over that same time, however, the number of teaching positions increased only 8% (McLeskey, Smith, Tyler, & Saunders, 2003). While the number of children and youth with ED has similarly grown, an accurate national picture of the actual number of newly prepared ED teachers has been elusive to date. In their survey of EBD teacher education programs, Maag and Katsiyannis (1999) received so few responses on the specific items regarding the number of program graduates that those data were unusable.

Efforts to Address Teacher Shortages

States and local school districts take a variety of approaches to dealing with shortages of special education teachers, including alternative certification. "Alternative certification" is a general term used to contrast a method of teacher preparation different from the standard program in which a teacher has been prepared in a state- approved teacher education program that combines aspects of specific subject-matter knowledge with knowledge of teaching and learning processes (adapted from Darling-Hammond, 2000, cited in Rosenberg & Sindelar, 2001). Alternative certification programs vary from traditional programs in three respects: length and structure of the program, delivery mode, and candidate population (Rosenberg & Sindelar, 2001 ).These factors may be attractive to nontraditional candidates who aspire to teach children with special needs.

The number of states implementing alternatives to the approved college teacher education program route for certifying teachers grew from 8 to 46 between 1983 an\d 2001. It is estimated that more than 150,000 persons have been licensed through these alternative programs (Feistritzer & Chester, 2001). Alternative certification programs play a significant role in individual states (Ruckel, 2000), particularly in states with large urban populations or where policies may spur rapid transitions to small student-teacher ratios.

Teacher shortages, high attrition, and the inadequate numbers of newly prepared teachers seriously limit the availability of teachers of children with ED. Responses to shortages such as alternative certification may alleviate some problems, but studies of ED teachers have yet to comprehensively explore the effect of such responses on workforce quality (Prather-Jones, 2003). The Study of Personnel Needs in Special Education (SPeNSE) was conducted, data from which were analyzed to explore the demographic characteristics, preservice preparation, future plans, and instructional practices of teachers of students with ED.

Study Overview

SPeNSE, funded by the U.S. Department of Education'sOfficeofSpecial Education Programs (OSEP), was designed to describe the quality of personnel serving students with disabilities and factors associated with workforce quality. Conducted during the 1999-2000 school year, the study included telephone interviews with a nationally representative sample of local administrators (358) and service providers (8,061), including elementary and secondary special and general education teachers, preschool special education teachers, speech-language pathologists, and special education paraprofessionals. This article includes results only for K-12 special education teachers. Comparisons are made between teachers who served primarily students with ED and other special education teachers.

Sampling

SPeNSE used a two-phase sample design. In the first phase, the sampling units were local education agencies (LEAs), intermediate education units (IEUs), and state schools for students with visual or hearing impairments. Samples of LEAs and IEUs were selected from Quality Education Data (QED), a database containing basic descriptive information on education agencies across the country. The sample of LEAs was stratified by geographic region and district size (i.e., total student enrollment). IEUs that did not employ staff who provide direct services to students with disabilities were deleted from the sampling frame, and then the IEU sample was stratified by geographic region. All (76) state schools were included in the first-phase sample.

The second phase was a stratified simple random sample of service providers (preschool teachers, teachers of students with visual and hearing impairments, teachers of students with emotional disturbance, other special education teachers, speech-language pathologists, special education paraprofessionals, and general education teachers) from rosters of personnel that were obtained from 370 participating LEAs, IEUs, and state schools.

The teaching assignments of teachers who served primarily students with ED were confirmed by their administrators and verified later as part of the interview. During data cleaning, teachers were reclassified who had been initially categorized as serving primarily students with ED but whose caseloads included more than half of students with other disabilities.

Survey Development

SPeNSE relied on two primary data collection instruments: a survey of local special education administrators and a survey of service providers. Data collection used computer-assisted telephone interviews and was conducted in 2000. The instruments were developed to describe the workforce and factors affecting workforce quality. To the extent possible, individual items were taken from previously used instruments (primarily the Schools and Staffing Surveys; National Center for Education Statistics, 2002) so extant data would be available for comparisons. Teacher quality measures were developed around five theoretical components of quality identified by Kennedy (1992): credentials, tested ability, professionalism, demographics, and classroom practices. Items on factors affecting workforce quality covered four broad areas: federal, state, and local policies; preservice education; continuing professional development; and working conditions.

The instruments were developed in consultation with a stakeholder group comprising federal, state, and local administrators; service providers; researchers; advocates; and teacher preparation personnel. A final draft was pilot tested in fall 1999 with three administrators and eight service providers, revised based on the results of the pilot test, and cleared by the U.S. Office of Management and Budget (OMB). The SPeNSE questionnaires are available at www.coe.ufl.edu/copsse.

Weighting and Item Nonresponse

SPeNSE data were weighted to generate national estimates. When analyzing survey data, nonparametric methods are used because the assumption of a specific parametric model cannot be made. Thus, the sample is selected with a positive probability for every element of the population so that it can be weighted to produce unbiased estimates for the parameters of the population of interest. The SPeNSE weighting was done in phases, reflecting the two-phase sample design. The weighting for the first-phase sampling units was based on the recruitment results, with minor adjustments. First, the recruited respondents were weighted by adjusting the base weights (inverse selection probability) for recruitment nonrespondents. After analyzing the response pattern using chi-squared automatic interaction detection (CHAID) analysis, first-phase nonresponse adjustment weighting was conducted within each of the 36 design strata (24 district size-region cells in the LEA sample, six regions in each of the IEUs, and state school samples). The CHAID analysis, in which weighting cells are created with similar response probabilities, was employed to account for the differential nonresponse tendency of the nonrespondents. This was designed to reduce the nonresponse bias as well as to enhance the efficiency of estimation of population parameters. After careful nonresponse weight adjustment, the weights for the LEA and IEU samples were further adjusted by poststratification weighting using teacher population data for the poststrata from the QED.

The service provider base weight, which was the multiple of its first-phase weight and the second-phase sampling weight, was adjusted to compensate for nonresponding teachers within each job assignment. CHAID analysis was performed to construct weighting cells for the weighting adjustment using design variables (region and district size) and some auxiliary variables from the QED. For the teacher data, no imputation was used because item nonresponse was very low.

Data Analyses

For this analysis, only K-12 special educators (n = 4,546) were included. Table 1 shows the total number of eligible teachers sampled and the number and percentage of respondents, by the teacher's field.

TABLE 1

Number of Eligible Teachers Sampled and Response Rates, by Teaching Field

Data analyses were conducted in WesVar, a statistical package designed to calculate estimates and variance estimates for data collected through complex sample designs (http://westat.com/wesvar/ ). These analyses included descriptive statistics, chi-squares, t- tests, and analysis of variance (ANOVA). Results presented in this report were weighted to produce national estimates.

When comparing three or more groups, significant differences were determined using ANOVA. When significant differences were present, we conducted pairwise post hoc comparisons.

Limitations

Only 46% (372) of sampled LEAs, IEUs, and state schools and 69% (8,061) of sampled service providers participated in the study. Therefore, the overall response rate was only 32%. Weight adjustments were carefully done to address nonresponse bias, but care should be taken in interpreting results. Post hoc comparisons of SPeNSE data with other data sources containing identical or similarly worded items (e.g., the National Center for Education Statistics, 2002, Schools and Staffing Survey) did not suggest any first-stage systematic nonresponse bias. A nonresponse study of 23 previously nonparticipating districts and 202 special education teachers conducted in fall 2002 as part of a SPeNSE follow-up survey did not uncover any significant systematic bias in the LEA sample.

Results and Discussion

ED teachers differed from all other special education teachers in several significant ways. This section reports and explores results on teachers' experience, assignment, credentials, preservice preparation, and future plans. A final section examines the self- reported use of best practices. Teachers of children with ED are compared with all other special education teachers throughout the article.

Years of Experience

ED teachers had fewer years of teaching experience than other special education teachers (mean 12 versus 14.7 years; p < .001), and they also had fewer years of experience in teaching special education (10 versus 12.7 years; p < .001). Table 2 presents data on the percentage of teachers of children with ED and other special education teachers with various years of teaching experience in any field. Table 3 presents similar data on experience teaching special education specifically. These data compare with the average general education teacher's 15.5 years of experience (Carlson, Brauen, Klein, Schroll, & Willig, 2002).

TABLE 2

Years Worked in Teaching

TABLE 3

Years Worked Specifically in Special Education Teaching

Years of teaching experience may be particularly germane to the perceptions of child behaviors held by teachers. In examining teachers' ratings of young children's behavioral problems, Kaiser and colleagues found that amount of teaching experience predicted ratings-that is, teachers with fewer than seven years' teachi\ng experience rated children's behaviors as more problematic (Kaiser, Cai, Hancock, & Foster, 2002). Perceptions of students' behavioral problems by ED teachers, who on average appear to have less teaching experience than their special education and general education colleagues, may be less positive than those of more experienced teachers.

Teaching Assignment

There were significant differences in the types of schools in which ED and other special education teachers worked (see Table 4). Seventy-eight percent of ED teachers compared with nearly 96% of non- ED teachers worked in regular elementary or secondary schools. ED teachers were frequently assigned to special education schools or program settings and to alternative schools.2 This approximates data reported by states, indicating that nationally, 82% of children with ED ages 6-21 are educated in regular school buildings; the rest are in separate public or private facilities, residential facilities, or home or hospital environments (U.S. Department of Education, 2002).

ED teachers differed from other special educators in the way their students were grouped as well as according to the variety of disabilities served. ED teachers served a more homogeneous group of students than their colleagues. While nearly half of other special education teachers served different groups of children during the day, the majority of ED teachers served the same group of students all day (see Table 5). Additionally, ED teachers taught children who had an average of two different types of disabilities, while other special educators served children with an average of three different types of disabilities. Table 6 describes the percentage of ED and other special education teachers who served students with different numbers of primary disabilities. ED teachers were more than twice as likely as other special educators to serve children with only one type of disability.

TABLE 4

Type of School at Which Teachers Work

Credentials

As a group, ED teachers were less credentialed than other special education teachers. Teachers of children with ED were less likely than other special education teachers to have a master's degree (52.9% versus 60.3%; p = .021) and less likely to be fully certified for their main teaching assignment (89.3% versus 92.8%; p = .002). They were also more likely to work under an emergency certificate (10.4% versus 4.0%; p = .002).

Alternative routes to certification were an important source of teachers to serve children with ED. Nearly twice as many ED teachers than other special education teachers were credentialed through an alternative certification program (11.7% of teachers of children with ED compared with 6.7% of other special education teachers; p = .006).

While state tests for certification or licensure may ensure that prospective teachers have specific knowledge and skills, the tests also affect the supply of candidates ready to enter the profession. In special education, it is not clear to what extent performance on these tests correlates with teaching quality. SPeNSE data reveal that a minority of teachers were required to take certification tests more than once in order to pass. A quantity of 22.1% of teachers of children with ED had to take tests at least twice; 16.5% of other special educators did so, a nonsignificant difference.

TABLE 5

Groupings of Children Typically Served by Teachers

Knowledge and Skills Taught in Teachers' Preservice Programs

Teachers who had been teachingsix or fewer years were asked about characteristics of their preservice preparation. Very few differences were found between teachers of children with ED and their special education colleagues in the content covered in preparation programs. Compared with other special education teachers, a smaller proportion of teachers of children with ED reported receiving any preservice preparation in planning effective lessons, teaching reading or prereading skills, interpreting the results of standardized tests, using literature in addressing problems or issues encountered in teaching, administering case management activities, collaborating with non-special education teachers, and collaborating with related services personnel. Differences in only one of these areas, however-collaborating with related services personnel-reached significance (41.6% of special education versus 32.7% of ED teachers; p = .025).

Similarly, in the two areas where more teachers of children with ED reported receiving preservice preparation-developing systematic behavior-management plans and assessing both appropriate and inappropriate behavior-no significant differences were found.

Intent to Remain in Special Education

Teachers were asked about their plans to remain in the teaching field or in special education. There was no significant difference in the pattern of responses of teachers of children with ED and other special education teachers. Almost 6% of teachers indicated they planned to leave teaching as soon as possible (5.9% of special education teachers and 5.7% of teachers of children with ED). The majority of teachers reported they planned to remain in teaching until retirement (63.5% of special education teachers and 58.5% of teachers of children with ED), and the remainder indicated they were either undecided or they planned to teach "until something else comes along" (30.5% of special education teachers and 35.8% of teachers of children with ED).

Teachers' Self-Assessments

The SPeNSE surveys sought information about teachers' use of best instructional and behavior-management practices. In the areas most closely related to student behavior (assessing both appropriate and inappropriate behavior and managing behavior), more teachers of children with ED rated themselves as being skillful to a great extent than other special education teachers (p < .001 for both; estimates for all self-assessment scales are in the Appendix). In other skill areas, however, teachers of children with ED perceived themselves as less skillful than other special education teachers. These areas included interpreting results of standardized tests (p = .01) and administering case management activities, including corresponding paperwork (p = .01). There was no difference between groups in the area of collaboration with non-special education teachers, including prereferral interventions.

The teachers were also asked to give a more global assessment of how successful they felt in providing the kind of education they would like to impart to most of their students with IEPs. Again, teachers of children with ED were less likely than other special educators to respond "to a great extent" (p = .01).

To aid in analysis, SPeNSE researchers created composite variables on the frequency with which teachers used selected best practices in reading, managing behavior, and inclusion. Because the scales had varying numbers of items depending on student characteristics (e.g., grade), they were rescaled so that possible scores ranged from O to 100. No significant differences between ED and other special education teachers were found in the reading scale (68.9 versus 67.0; p = .419), but teachers of children with ED reported using best practices in behavior management more frequently than other special education teachers (73.0 versus 54.7, p < .001). Teachers of children with ED reported using best practices in inclusion less frequently than their colleagues (59.2 versus 69.1, p < .001). This may reflect the larger percentage of teachers of children with ED who worked in self-contained classrooms.

Conclusion

Several substantive challenges face the preparation of teachers of children and youth with emotional disturbance. Personnel shortages are real and, by most projections, are becoming increasingly severe. Although several innovative techniques and programs are available to recruit and retain qualified personnel, inadequate preparation for managing classroom behavior remains a real challenge (e.g., Angelle, 2000; Freiberg, 2002). Previous research confirms that special education teachers leave the profession at alarming rates and that teachers of children with ED may have even higher attrition (Billingsley, 2004; Lauritzen & Friedman, 1991). Alternative certification holds some potential for addressing personnel shortages, though significant variation in program type and quality may limit its usefulness for preparation of special educators, especially teachers of children with ED.

Findings from the Office of Special Education Programs' Study of Personnel Needs in Special Education shed some important light on the working conditions, experiences, and skills of teachers who serve children with ED and other special education teachers. These nationally representative data reflect the first major effort to examine the factors that may distinguish teachers of children with ED from their special education colleagues and, in turn, may explain some of the challenges of securing an adequate supply of personnel qualified to teach children with ED.

While teachers of children with ED are, on average, less experienced than other special education teachers in teaching and in teaching special education specifically, more than half of the ED teaching force has more than 10 years' experience. Over the past 20 years, research has shown a consistent, positive relationship between teachers' experience and student achievement (Biniaminov & Glasman, 1983; Lopez, 1995;Murnane, 1981) at the individual, classroom, school, and district levels (Ferguson, 1991;Murnane, 1981; Turner & Camilli, 1988; Wendling & Cohen, 1980). After controlling for many other factors, Ferguson (1991) found that students in districts with more experienced teachers performed better. The percentage of a district's teachers having five to nine or nine or more years of experience accounted for more than 10% of the interdistrict variance in student test scores. For element\ary school teachers, experience beyond five years did not contribute to enhanced achievement, but it did for high school teachers. Based on studies of classes and schools in two U.S. cities, Murnane (1981 ) reported that teachers with three to five years of experience were more effective than those with fewer than three years of experience. Classes with teachers who had three to five years of teaching experience averaged two to three months' more reading progress in second grade than classes with first-year teachers.

While years of experience likely contribute to the effectiveness of teachers of children with ED, personnel shortages may be exaggerated by the graying of the education workforce (Hussar, 1999). In 2000, the average age for special education teachers was 43 (U.S. Department of Education, 2002, May 7). In addition, traditional preservice teacher preparation programs do not appear to be sufficient to meet demand.

The reliance of schools on teachers of children with ED who hold emergency certification or certification obtained through alternative certification programs demands further exploration. Teachers of children with ED were more likely than other special education teachers to work under emergency certificates or be credentialed through alternative certification programs. Though more is being learned about the array and types of alternative certification programs available, there is limited research on the outcomes of students with disabilities served by teachers with alternative versus traditional certification.

SPeNSE data did not allow for examination of the use of noncategorical or cross-categorical approaches to certifying teachers of children with ED. Future research needs to address both the prevalence and impact of different types of certification on teachers' intent to stay and self-assessments of instructional and behaviormanagement practices.

Isolation of teachers of children with ED is another factor worthy of examination. They are more likely than their special education colleagues to teach in segregated schools or other nonregular school settings. In addition, nearly 40% of teachers of children with ED serve the same group of students all day, and the same amount report serving only one type of disability. While the increased use of inclusive settings may be alleviating some of the traditional isolation of special education teachers, teachers of children with ED appear to be disproportionately assigned to segregated settings, responsible for homogenous groups of students with ED.

It is encouraging that teachers of children with ED report greater skills in areas of managing and addressing behavior. Classroom management is one of the oft-cited challenges for all teachers. Litigation over the past decade reflects some level of incompetence on the part of general educators who have had inadequate training in behavior management (Katsiyannis, Acton, Ellenburg, & Lock, 2000). Evidence favors the use of classroom management techniques to prevent later aggressive and antisocial behaviors. For example, a lack of effective disciplinary procedures in the elementary school classroom many have important developmental consequences for future maladaptive behaviors (Greer-Chase, Rhodes, & Kellan, 2002). Prevention of disciplinary problems and maladaptive behaviors may rest with the appropriate preparation and continued professional developmentof teachers to manage elementary school classrooms (Greer-Chase et al., 2002). Teachers of students with ED face significant, critical behavior-management tasks. The findings from SPeNSE indicate that of all special education teachers, teachers of children with ED appear best prepared to master those specific tasks.

1 Because of its use in federal law and in the SPeNSE study, the term "emotional disturbance" is used throughout this article. Terms used by the original authors in the cited literature are honored.

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U.S. Department of Education, Office of Special Education Programs. (2002, May 7). SPeNSE Summary Sheet. Recruiting and retaining high-quality teachers. Retrieved October 4, 2005, from http://ferdig.coe.ufl.edu/spense/ policymaker5.pdf

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Kelly Henderson

George Mason University

Sheri Klein

Westat

Patricia Gonzalez & Rene Bradley

U.S. Institute of Education Sciences

NOTE

The Study of Personnel Needs in Special Education was supported by the U.S. Office of Special Education Programs and conducted by Westat. However, the opinions expressed herein are those of the authors and do not necessary reflect the policy or position of the U.S. Department of Education, the Office of Special Education Programs, or Westat, and no official endorsement should be inferred.

Address correspondence to Kelly Henderson, Adjunct Faculty, George Mason University, 404 Windover Ct., NW, Vienna, VA 22180; Khender8@gmu.edu

APPENDIX A

APPENDIX A

Copyright Council for Children with Behavioral Disorders Nov 2005


Source: Behavioral Disorders

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