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Programs for Children and Adolescents With Emotional and Behavioral Disorders

Posted on: Tuesday, 21 March 2006, 06:00 CST

By Bullock, Lyndal M; Gable, Robert A

ABSTRACT:

In this article, the authors briefly review the historical development and current status of services for students with emotional/behavioral disorders (E/BD) in the United States. Drawing upon that review, the authors examine disproportionality and personnel shortages and discuss present and future options for better serving this challenging population of children and youth.

KEY WORDS: emotional/behavioral disorders (E/BD), legislative initatives, mental health.

As far back in history as Hippocrates (400 BC). there have been advocates with courage to speak out on behalf of individuals who demonstrated such abberant behavior that it jeopardized their ability to fit into society. These early advocates were concerned primarily with the struggles evidenced by adults. In the United States, it was not until the latter part of the 19th century that concern began to be expressed for the welfare of children and adolescents (e.g., provisions for truant and disobedient children in New Haven, CT, and New York City). It was only early in the 20th century that we began to see emphasis placed on the mental health needs of children and adolescents-an emphasis that has become increasingly pronounced over time. The following paragraphs are several examples of events that have affected the development of services for children and adolescents with special needs.

* Establishment of professional groups (e.g., National Committee on Mental Hygiene [ 1909]: Council for Exceptional Children at Columbia University [1922]; American Orthopsychiatric Association [1924]; Council for Children with Behavioral Disorders, a division of the Council for Exceptional Children [1964]; National Mental Health and Special Education Coalition [1987]; Federation of Families for Children's Mental Health [1989]).

* Implementation of models for direct services to children and adolescents with emotional/behavioral problems (e.g., Juvenile Psychopathic Institute in Chicago [1909], Clinic for Child Development at Yale University [1911], Bellevue Psychiatric Hospital school in New York City for children with psychosis [1935], Orthogenie School at the University of Chicago [1944], New York City Board of Education "600 schools" for disturbed and socially maladjusted children/youth [1946], League School in Brooklyn [1953], Project Re-Ed [1961], Engineered Classroom [1968]).

* Dissemination of authoritative reports on how to work with children and adolescents with emotional and behavioral needs (e.g., Berkowitz & Rothman, 1960; Bower, 1960; Grosenick & Huntze, 1979; Haring & Phillips, 1962; Hewett, 1968; Hobbs, 1975a, 1975b; Kanner, 1935; Osher & Hanley, 1996; Morse, Cutler, & Fink, 1964; Redl & Wineman, 1951; Rhodes & Tracy, 1972; Strauss & Lehtinen, 1947).

* Actions of the federal government and other developments affected services to children and adolescents with emotional and mental health needs.

Among the first signs of problem recognition and involvement of the federal government regarding mental health services for children was the establishment of a Children's Bureau in the 1930s (Jones, 1999), which sought to promote child mental health services. Although the creation of a Children's Bureau represented a positive step, the bureau failed to put forth any policies regarding child mental health services.

In 1984, the National Institute of Mental Health established the Child and Adolescent Service System Program (CASSP), from which emerged a policy that produced what is now known as "A System of Care for Children and Youth with Serious Emotional Disturbances" (Stroul & Friedman, 1986). This system of care had four major goals: (a) to encourage the creation of interagency systems of care to help ensure that the mental health needs of children and their families would be met, (b) to enhance the role of mental health agencies within multiagency systems, (c) to enhance the role of family members' involvement in designing and implementing supportive care, and (d) to encourage cultural competence of service providers by recognizing "the need for members of culturally diverse groups to have input into how the system of care is created and how the interventions they and their children receive approach their unique cultural values " (Lourie & Hernandez, 2003, p. 7).

The U.S. Congress passed the Alcohol, Drug Abuse Mental Health Administration Reorganization Act in 1992. This law strengthened the development and support of systems of care for children and adolescents with serious emotional disorders and their families.

In addition to the aforegoing, there were two major legislative initiatives enacted in the 20th century that had an immediate and dramatic effect on services for children and adolescents with emotional/behavioral disorders (E/BD). Signed into law in 1963, the Mental Retardation Facilities Construction Act, RL. 88-164, was the first federal legislation in the United States to provide funds to institutions of higher education to assist in the preparation of education personnel to work with students with all types of disabilities, including those with emotional problems. In 1975, RL. 94-142: The Education for All Handicapped Children Act, was enacted, which required that "a free appropriate public education" (FARE) be provided for all children with disabilities. This law has been amended and reauthorized several times, the most recent of which was RL. 108-446, which passed in 2004. The title of the law was changed in 1990 to Individuals with Disabilities Education Act (IDEA).

The field of E/BD has an interesting albeit relatively brief history (Gable & Bullock, 2004). History accounts highlight the significant contributions of professional groups, researchers, and the federal government. It is because of these tireless efforts of many dedicated and capable professionals that the field has progressed to its current status. Although we have "come a long way" in providing services to children and adolescents, the field still faces numerous critical challenges for which we must continue to seek answers. Some of the most daunting challenges include the need to provide (a) appropriate identification and assessment of children and adolescents to avoid the over- and underrepresentation of different ethnic groups (e.g., Fox & Gable, 2004; Mattison, 2004; Shriner & Wehby, 2004); (b) a continuum of services for children and adolescents with E/BD (e.g., Johns & Guetzloe, 2004; Muscott, Morgan, & Meadows, 1996); (c) classroom instruction that is individualized and that emphasizes academics and social development versus a curriculum of control (e.g., Knitzer, Steinberg, & Fleisch, 1990); (d) fair and nondiscriminatory disciplinary practices that take into consideration individual student needs (e.g., Cartledge et al., 2002; Obiakor et al., 2002); (e) an adequate supply of highly qualified personnel who can provide a positive and nurturing learning environment for students (e.g., Bullock, 2004; Cartledge, 2004; Gable & Bullock; Obiakor, 2004; Rosenberg, 2004; Van Acker, 2004); (f) a comprehensive systems-of-care that incorporates education, mental health, child welfare, and other services that may be needed (e.g., Knitzer et al., 1990; Skiba, Polsgrove, & Nasstrom, 1996); and (g) positive behavioral interventions and supports that will enhance the strengths of the child/adolescent (Lewis, 2004).

Although these challenges are worthy of further discussion, space limitations prohibit us from addressing all of them. In the remainder of this article, we will present a brief overview of the services provided in schools for children and adolescents with E/BD and briefly discuss two challenges facing the field, namely, disproportionality and personnel shortages.

Services in Schools

In this section, we provide an overview of service provisions for students with disabilities, with a focus on students with E/BD.

Since 1976-1977, the U.S. Department of Education has collected and reported on an annual basis the number of students, ages 6-21 years, with disabilities who receive services under the IDEA. This represents each of the 13 disability categories that are in the federal statutes: specific learning disabilities, speech/language impairments, mental retardation, emotional disturbance, multiple disabilities, hearing impairments, orthopedic impairments, other health impairments, visual impairments, autism, deaf-blindness, traumatic brain injury (TBI), and developmental delay. In the 25 years since the inception of the federal statute (RL. 94-142: Education for All Handicapped Children Act), the number of students with disabilities who receive services has grown to over 5 million. Based on data from 2000-2001 (United States Department of Education. 2002). in the past 10 years, there has been an increase of about 289c in the number of students with disabilities served through IDEA. The category of emotional disturbances represents 8.2% of all students served. Table 1 presents the numbers of students with disabilities served, based on data reported for 2000-2001. as compared with those with E/BD.

There is consensus among pr\ofessionals that all children and adolescents receive their education in the most appropriate and least restrictive setting possible. Some (e.g., Stainback, Stainback, & Ayres. 1996) have interpreted the least restrictive environment as being synonymous with full inclusion into general education classrooms and programs. We believe that what constitutes the least restrictive environment represents a pupil-specific decision based on the strengths and weaknesses of that individual. For example, the least restrictive setting might be a highly structured, supportive classroom for children with E/BD. In such an environment, a child may be able to thrive, learn new behaviors, and make academic progress, whereas, in a less structured setting, a child might not develop socially and academically as would be expected. Others (e.g., Johns & Guetzloe, 2004; Kauffman & Hallahan. 2005) have maintained that while inclusion for students with E/BD should be maintained as a goal, the reality is that many students with E/BD have a very difficult time in inclusive classrooms. This difficulty may be attributed to several factors. Students with so- called externalizing behavior problems (e.g., antisocial, aggressive, acting-out behaviors) are able to disrupt events in any setting. Because no one tolerates disruptive behavior, these students are viewed as "troublemakers" and their behaviors are broadly considered unacceptable in the classroom. In addition to the "troublemaker" types, there are many students whose behaviors are not as intense, but potentially as problematic. These students demonstrate behaviors that may range from being distractible, noncompliant, and off-task to fearful, anxious, and socially withdrawn. Students with what are characteri/.ed as internali/ing behavior problems present unique problems to school personnel. For example, it is often difficult to actively engage these students in learning activities. Many of these students appear to be unmotivated, passive, and disinterested in their schooling, whereas others may seem overanxious, phobic, or social isolates. All across the country, schools are struggling to deliver adequate education and supports for students with E/BD who are placed in the general education classroom. Few general education teachers have the skills to select appropriate strategies and systematically teach students with severe E/BD.

TABLE 1. Number of Children With Disabilities and Emotional or Behavioral Disorders (E/BD) Served Under Individuals With Disabilities Education Act, 2000-2001

We only have to talk with teachers of students with E/BD to understand what a difficult, but potentially rewarding, task it is to teach these students. Classroom interventions must be group individualized, intense, and coordinated among school personnel, community support personnel, and the family. Behavior interventions stem from a comprehensive functional behavioral assessment in which data are collected from various school personnel, parents, and others who interact with the individual. Once teachers develop a sound plan of intervention, it must be executed with a high degree of fidelity. Academic intervention must be group individualized as well and be predicated on direct and continuous assessment of specific subskills. In that learning and behavior problems go hand in hand, it is essential to merge academic/behavioral programs. When planning interventions, it is important to keep in mind that the ultimate goal is to teach the students skills that will enable them to regulate their own behaviors that according to Polsgrove and Smith (2004). include "being better able to control their emotional reactions, adjust to complex social situations, deal with challenging academic and social difficulties, manage anxieties, and achieve personal goals" (p. 400).

Given the complexity of designing and implementing quality programming for students with EiBO. it is not surprising that this population often receives services outside of regular education. Table 2 reflects the various educational settings in which students with disabilities, including E/BD. are served. As can be seen, the largest percentage of students between the ages of 6-17 years with E/ BD receive services outside the regular setting in public schools. Finally, although less prevalent, residential facilities and hospital settings are still placement options.

In recent years, an impressive number of evidence-based practices have emerged that, when used appropriately, are highly effective in serving students with E/BD. For example, we have witnessed remarkable progress in refining strategies for selfmanagement and self-regulation. However, the challenge remains to engage in research that enlarges our ability to work successfully with students with challenging behaviors and to find ways to encourage and support teachers to implement with fidelity the practices that have already proven effective (Landrum, Tankersley, & Kauffman, 2004; Tankersley, Landrum, & Cook, 2004).

Disproportionality in Programs for Students With E/BD

The demographics in America's schools are changing at a rapid pace. This change is more dramatic in some states than in others (e.g., Arizona, California, Florida, Texas). Because of these changes, one of the most daunting challenges facing educators relates to how we can meet the needs of all learners-learners who come from increasingly diverse cultural, racial, linguistic, and socioeconomic backgrounds (Obiakor, 2004; Obiakor & Wilder, 2003). Special education is often criticized, and rightfully so, for the minority disproportionality that exists in some of its programs. Some ethnic groups (e.g., African Americans) tend to be overrepresented (Cartledge et al., 2002; Fierros & Conroy, 2002), whereas other groups (e.g., Asians) tend to be underrepresented (Parrish, 2002) in programs for students with E/BD. We must recognize, however, that identification rates are not consistent and vary by state and school district. For example, Cohen and Osher (1994) found that African American students were likely to be overidentified in districts in which they constituted a minority of the school population, but tended to be underidentified in districts in which they were the predominant group. According to Artiles, Trent, and Palmer (2004), placement data for Hispanics indicate that they typically are underrepresented in high-incidence disability areas. Table 3 provides an overview of the percentage of students from various racial/ethnic backgrounds, ages 6-21 years, with E/BD served under IDEA.

TABLE 2. Type of Educational Setting in Which Children With Disabilities Were Served Based on 1999-2000 Data, Reported by Percentage of Children

There has been widespread, and sometimes contentious, debate (e.g., Riccio, Ochoa, Garza, & Nero, 2003; Skiba, Simmons, Ritter, Kohler, & Wu, 2003; Skrtic, 2003) over the causes of the disproportionate representation that exists among students. Misdiagnosis, according to Obiakor et al. (2002) and Riccio et al, often occurs because of (a) language differences that may impede the child's academic and social competence, (b) faulty perceptions by teachers who have lowered academic expectations for culturally and linguistically different students, and (c) bias. Cartledge et al. (2002) and Obiakor et al. (2004) discuss bias as an issue in the identification process. Bias may include (a) cultural differences, (b) neighborhoods of residence where students learn to act and behave in certain ways, (c) peer group expectations that conflict with school values, (d) language differences, (e) country of origin, (f) religious beliefs and their impact on daily living activities, (g) socioeconomic status, and (h) child-rearing practices in the home.

The issue of disproportionality in identification continues to be a serious problem. It is unfortunate that research has yet to provide any definitive answers as to how to overcome this problem (Kauffman, 2005; Osher et al., 2004). Some authorities (e.g., Cartledge et al., 2002; Obiakor et al., 2002) have suggested that as school personnel become more aware of cultural differences that affect individual student learning and behavior, they will make better decisions concerning for whom and when to make referrals. Furthermore, if school personnel make better use of functional behavioral assessments in the identification and assessment process, it is likely that better decisionmaking will occur in planning ways to promote positive academic and behavioral outcomes.

Personnel Shortages and the Effect on Services

The overall outcomes for children with or at risk for E/BD are appalling. Outcomes, cited by the U.S. Department of Education and others (e.g., Knitzer et al., 1990; United States Department of Education, 1999, 2000, 2001, 2002, indicate that children and adolescents with E/BD fail more courses, earn lower grade point averages, miss more days of school, and are retained a grade more often than other students with disabilities. They are at increased risk for alcohol, tobacco, and drug use. In addition, 55% leave school before graduating and only 42% graduate on schedule (Wagner, 1993). According to Wagner, Cameto, and Newman (2003), about 58% of students with E/BD are arrested 3-5 years out of high school. As we have argued, school factors such as a lack of academic and social supports, reactive teaching styles, and frequent changes in placement contribute significantly to these poor outcomes (e.g., Mayer, 1995; Munk & Repp, 1995; Osher & Hanley, 1996; Van Acker, 2004; Wagner et al).

Another factor that contributes to poor outcomes for elementary school-age children is the failure to identify early students at high risk (Conroy. 2004) and, thus, introduce interventions accordingly. Research has shown that emotional and behavioral problems that are identified during adolescence often stem from early behavioral patterns that went untreated (Gagnon \& Mayer, 2004). Another factor may be that culturally sensitive approaches are not introduced to accommodate children from ethnically or linguistically diverse backgrounds (Comer. 1996: Obiakor et al., 2004). According to several authors (e.g., Cessna & Skiba, 1996; Johns & Guetzloe. 2004). some programs for children and adolescents with E/BD fail to address the individual needs of children or fail to use empirically supported practices (e.g., Bullock & Gable, 2004; Johns & Guetzloe).

TABLE 3. Percentage of Children by Age and Race or Ethnicity With Disabilities and Emotional or Behavioral Disorders (E/BD) Served Under Individuals With Disabilities Education Act, 2000-2001

Notwithstanding the magnitude of these problems, research indicates that outcomes for children and adolescents with E/BD can be greatly enhanced through interventions that (a) are sustained, flexible, positive, collaborative, culturally appropriate, and regularly evaluated: (b) are built on the strengths of the students and their families: and (c) address academic as well as social behavioral deficits (Gardner & FrazierTrotman, 2001 ; Van Acker, 2003). Furthermore, it is essential that these interventions be delivered by well-prepared, competent, and supportive educational professionals.

Today, in many parts of the country, schools face critical shortages of qualified teachers and resource personnel to work with children and adolescents with disabilities: however, this is not a new phenomenon. Furthermore, it is well documented that a serious shortage exists among qualified personnel serving in the area of E/ BD (e.g., Boe, Bobbin, Cook, Barkanic, & Maislin, 1998; Brownell & Smith, 1992; Darling-Hammond & Ball, 1997; Obiakor. 2004; United States Department of Education, 1996. 2002; Van Acker. 2004). According to a recent report (Boe, Cook. Bobbitt. & Terhanian. 1998), teacher shortages for students in the 6-21 years age category are acute. For example, in fall 2003. it was estimated that there were over 69,000 teacher vacancies in special education in the United States (L. Danielson. personal communication. February 17, 2004). With an increasing school-aged population, that number is expected to grow dramatically within the next decade (Van Acker).

Compounding the problem inherent in shortages of qualified classroom personnel is the increasing number of new immigrant children to America's schools, many of whom are non-English speakers. The effect is already being felt, particularly in the southern Mexican border states (i.e., Texas, Arizona, and California) and Florida. For example. Texas authorities estimate that by the year 2030, the African American population will increase by about 7%. but the Hispanic population is predicted to escalate up to 669r (Murdock. Hogue, Michael, White, & Pecotte. 1997).

Another impediment to overcoming the dearth of qualified teachers is the lack of college and university personnel who have the knowledge and experience to prepare adequately teachers of students with EfBD. In an analysis of personnel needs in Institutions for Higher Education (IHEs). Sindelar and Rosenberg (2003) reported that the number of IHE teaching positions is accelerating and the projected supply is insufficient to meet the growing demand for classroom personnel. Based on 1998 projections by the National Center for Educational Statistics (1997), school districts will need to hire over 2 million teachers by 2008, which assumes alarming proportions when it is juxtaposed to numbers that reflect a sharply declining leadership pool.

Conclusion

Most experts would agree that the field of E/BD has an exciting and dynamic history. In spite of the progress made over the years, our work has just begun. The magnitude of the challenges demand our best efforts to ensure high-quality services to students who struggle to be the best they can become.

We cannot expect that appropriate educational programming will occur without teachers who have an understanding of E/BD and who possess the skills to plan and implement management and instructional strategies that meet the individual needs of students. In the rush to fill classrooms with teachers, numerous alternative licensure frameworks, designed to fast track training, have emerged (Rosenberg & Sindelar, 2001). It is unfortunate that many of these fast-track programs fail to produce teachers who possess the prerequisite skills to provide quality instruction to students with E/BD and to ensure positive academic and behavioral outcomes.

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Lyndal M. Bullock is a regents professor in the Department of Special Education at the University of North Jexas, Denton. Robert A. Gable, an executive editor for Preventing School Failure, is an eminent scholar in the Deportment of Special Education at Old Dominion University, Norfolk, Virginia. Copyright 2006 Heldref Publications

Copyright Heldref Publications Winter 2006

Source: Preventing School Failure

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