An Exploratory Evaluation of Conjoint Behavioral Consultation to Promote Collaboration Among Family, School, and Pediatric Systems: A Role for Pediatric School Psychologists

Abstract

Pediatric school psychology is a relatively new subspecialty in the field; however, few specific, prescribed roles have been articulated, and fewer have yielded preliminary efficacy data. In this exploratory study, the acceptability and potential efficacy of conjoint behavioral consultation (CBC) as a model for linking families, schools, and pediatric settings to address concerns for children with medical issues were evaluated. Twenty-nine children, their parents, teachers, and consultants were involved in conjoint consultation, a model of cross-system collaboration to address shared concerns of medically referred children. In this structured indirect service delivery model, parents, teachers, and school psychology pediatric consultants worked collaboratively in interdisciplinary problem solving and joint decision making with extensive input regarding medical issues from a developmental pediatrician. Outcome measures included parent and teacher observations of child functioning across home and school settings as a result of consultation-mediated interventions and social validity indices assessing acceptability and consumer satisfaction. Results suggested that CBC is a socially valid procedure for addressing concerns of medically referred children across home and school systems. Both parents and teachers reported the consultation process to be highly acceptable. Preliminary effect size analyses of child outcomes, derived from uncontrolled case study designs, suggest generally positive effects across home and school, although limitations with the methodology preclude conclusive statements. Research is needed to determine the contexts and conditions under which the model is more or less effective using rigorous controlled trials.

Notes

Note: The authors report that to the best of their knowledge neither they nor their affiliated institutions have financial or personal relationships or affiliations that could influence or bias the opinions, decisions, or work presented in this manuscript. No such conflicts of interest have occurred in the past five years, and none are anticipated in the foreseeable future.

This article was received during the Editorship of Emila Lopez. Stephen D. Truscott, Editor Elect, served as action editor.

^aEffect sizes represent average effects across home and school outcomes. Effect size is calculated using a “no assumptions approach” (Busk & Serlin, 1992).

^bBehaviors listed represent those targeted at home and school, respectively. Effect sizes are those obtained at home and school, respectively.

^a Mdn = Median.

^b BIRS-R = Behavior Intervention Rating Scale-Revised (Acceptability factor), measuring acceptability of CBC, with possible mean item scores ranging from 1 (not at all acceptable) to 6 (highly acceptable).

^c GAS = Goal Attainment Scaling, measuring attainment of consultation goals, with scores ranging from 1 (goal not met; situation got significantly worse) to 5 (goal completely met).

^d CEF = Consultant Evaluation Form, measuring satisfaction with consultation services, with possible mean item scores ranging from 1 (not at all satisfied) to 7 (highly satisfied).

Because the primary emphasis of the project was training, rigorous experimental research designs were not imposed. A number of limitations are apparent with the case data reported, including lack of experimental control, variability in presenting target behaviors, coexisting interventions that vary across participants, and lack of reliability and objectivity in behavioral data. Thus, data are primarily descriptive and exploratory in nature, and results should be interpreted with caution.