To match or not to match students to intervention? That is the question.

1/22/2019


Jan. 22, 2019

Dr. Clay Cook

In light of the unsatisfactory outcomes of current intervention approaches, researchers and practitioners across various disciplines have advocated for more precise approaches that enhance the degree to which supports are appropriately matched to the individual. Indeed, evidence across medicine, psychology, and education has emerged supporting approaches that strategically match supports to individual need. Unfortunately, intervention programming in most schools often lacks the use of a matching process that seeks to tailor interventions to students based on need, which prevents students from accessing effective supports and is wasteful of educators’ time. 

Precise selection and delivery of interventions produces superior outcomes

School-based research has produced a steady stream of evidence-based interventions (EBIs) for students with social, emotional, and behavioral (SEB) problems (for example, Check-in/Check-out, small group skills training, behavioral contracts, self-monitoring, school-home note, etc.). Yet schools often struggle to keep stock of these EBIs and understand which students with SEB problems would benefit from which ones. Recent research has shown that strategically matching students to interventions within a menu of options has been shown to produce superior outcomes to the standard protocol approach in which all students receive the same intervention (that is, one-size-fits-all approach). For example, it is common in many schools to utilize a one-size-fits-all approach to intervening with students with SEB problems that involves all students receiving Check in/Check out, which is a structured school-based mentoring program, or social skills training group. Although both Check in/Check out and social skills training have evidence to support their use, the selection and delivery of these interventions for every student with SEB problems is imprecise and likely effective for some students and ineffective for other students.

Effective matching starts with identifying ‘why’ the problem is happening

Effective approaches to match students to intervention involves conducting brief pre-intervention assessments that capture the hypothesized root cause of the SEB problem that explains ‘why’ the problem is happening. The hypothesized root cause is then linked to a specific intervention. Ultimately, matching seeks to get the “right intervention in place for the right student” and is likely to produce superior outcomes relative to a standardized one-size-fits-all (that is, all students receive the same intervention regardless of need) or trial-and-error approach. For example, a student who has reading problems may be struggling due to inaccurate reading, accurate but slow reading, or insufficient motivation to engage in reading activities. The intervention would depend on the hypothesized root cause driving the reading problem (for example, word recognition/decoding intervention, fluency intervention with practice and feedback, or motivation enhancement intervention).

Matching takes into account the root cause of the problem and the student’s needs

Matching fundamentally recognizes that students with SEB problems are heterogeneous. The aim when matching is to find homogeneity within heterogeneity. In plain English this means that within the group of students who exhibit SEB problems the aim is to identify students with similar hypothesized root causes and needs. For example, going back to the example of Check-in/Check-out, the effectiveness of this intervention is driven by an adult’s attention and therefore is most effective for the sub-group of students who have motivational deficits and need extra support to encourage and reinforce expected behavior and for whom adult attention serves as a reinforcer. On the other hand, Check-in/Check-out is likely ineffective for students who need to be taught certain skills they are lacking (for example, emotion regulation skills) and/or who do not seek and respond well to adult attention. Effective approaches to matching take into account the heterogeneity/variability among students with a given problem and seek to identify who is likely to benefit from which of evidence-based intervention.  A recent special issue in the Journal of School Psychology has brought attention to matching students to intervention for students with differing needs (reading, behavioral, math), and has provided evidence for enhancing outcomes by adopting precision approaches. 

Research-based technology to facilitate precise matching

Additionally, researchers have helped develop technology to facilitate efforts to match students to more precise and effective interventions. For example, in the area of academics Spring Math, A2i – Assessment 2 Intervention, and FastBridge are web-based systems that include algorithms that inform matching students to more precise academic interventions. In the area of behavior, the IM4 system embeds a precision approach to matching students to intervention as the first step in the intervention programming process for students with SEB problems. Specifically, it includes the Student Intervention Matching System, which includes algorithms that match students to more precise and likely effective interventions within a menu of evidence-based interventions based on data regarding the hypothesized root cause driving the students’ SEB problem. Subsequent intervention programming steps involve mapping out an implementation plan to increase intervention fidelity, progress monitoring student response and intervention fidelity, and meeting as a team to review data to make decisions with regard to the next action steps to support the student.

The effectiveness of matching depends on the quality of the model used to recognize the problem’s root cause

Thus, when confronted with the question “To match or not to match students to interventions?” the science of effective intervention programming would unequivocally say match. However, the effectiveness of a matching approach rests with the quality of the theory or paradigm used to identify the hypothesized root cause that explains why the identified problem is happening. Wonky theories or paradigms will produce wonky interventions. For example, a theory that says the student’s SEB problem is due to the student’s consumption of food with red dye in it, not only will result in an intervention that will not work but it will deprive the student of receiving a needed, effective intervention. Also, the theory or paradigm needs to connect the hypothesized root cause to interventions educators have control over implementing. For example, a theory that suggests the root cause is due to the student’s genetics, although it may be true, does not lend itself to interventions the educators have control over implementing. Instead, educators need a sound, evidence-based theory that leads to the development of defensible hypothesis statements regarding the root cause underlying the student’s SEB problem and is linked to interventions that educators have the ability to implement.  The IM4 matching process is built upon the acquisition-performance model that seeks to determine whether the student’s SEB problem is happening because the student lacks a skill/behavior that is being demanded by the school environment or happening because the student is insufficiently supported and motivated by the environment to use skills they already possess and are capable of using. 

 

About the Author: Dr. Clay Cook is the John and Nancy Peyton Faculty Fellow in Child and Adolescent Wellbeing at the University of Minnesota and Associate Professor in the School Psychology Program. He has extensive research and practical experiences involving the implementation of multi-tiered systems of support to promote children’s social, emotional and behavioral wellbeing as the foundation for academic and life success.

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