A teacher-consultation approach to social skills training for pre-kindergarten children: treatment model and short-term outcome effects.

Abstract

This study evaluated the post-treatment outcome effects of a classroom-based social skills program for pre-kindergarten children, using a teacher-consultation model. The pre-K RECAP (Reaching Educators, Children, and Parents) program is a semi-structured, cognitive-behavioral skills training program that provides teachers with in-classroom consultation on program implementation and classroom-wide behavior management. Data on children's social skills and behavior problems were collected from parents and teachers at pre- and post-treatment, for 149 children aged 4-5 years (of whom 56% were girls). Significant treatment effects were found for teacher but not parent reports, with treatment group children improving significantly more than comparison group children in their teacher-rated social skills and internalizing and externalizing problems. These results provide some preliminary support for the efficacy of the program on children's social skills and behavior problems, and for a teacher-consultation model for training teachers to implement school-based mental health programs.

Full text

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Journal of Abnormal Child Psychology, Vol. 33, No. 6, December 2005, pp. 681–693 (C ?2005)
DOI: 10.1007/s10802-005-7647-1
A Teacher-Consultation Approach to Social Skills Training
for Pre-Kindergarten Children: Treatment Model
and Short-Term Outcome Effects
Susan S. Han,1,5Thomas Catron,2Bahr Weiss,3and Kristen K. Marciel1,4
Received June 12, 2003; revision received May 5, 2004; accepted June 21, 2004
This study evaluated the post-treatment outcome effects of a classroom-based social skills program
for pre-kindergarten children, using a teacher-consultation model. The pre-K RECAP (Reaching
Educators, Children, and Parents) program is a semi-structured, cognitive-behavioral skills training
program that provides teachers with in-classroom consultation on program implementation and
classroom-wide behavior management. Data on children’s social skills and behavior problems were
collected from parents and teachers at pre- and post-treatment, for 149 children aged 4–5 years (of
whom 56% were girls). Significant treatment effects were found for teacher but not parent reports,
with treatment group children improving significantly more than comparison group children in their
teacher-rated social skills and internalizing and externalizing problems. These results provide some
preliminary support for the efficacy of the program on children’s social skills and behavior problems,
and for a teacher-consultation model for training teachers to implement school-based mental health
programs.
KEY WORDS: school-based intervention; teacher consultation; pre-kindergarten; social skills; behavior
problems.
It has been estimated that at any given point in time,
between 12 to 20% of children and adolescents in the
general population have a diagnosable mental health dis-
order (Institute of Medicine, 1989), with prevalence es-
timates reaching up to 30% for children from high-risk,
socio-economically disadvantaged backgrounds (Raadal,
Milgrom, Cauce, & Manci, 1994; Tolan & Henry, 1996).
Even preschool children can be at risk for serious emo-
tional and behavioral difficulties, with some studies re-
porting that approximately 20% of preschool children in
the general population show moderate to clinically signif-
1Institute for Public Policy Studies, Vanderbilt University.
2Department of Psychiatry, Vanderbilt University.
3Department of Psychology and Human Development, Vanderbilt
University.
4Currently at Department of Clinical and Health Psychology, University
of Florida.
5Address all correspondence to Susan S. Han, Vanderbilt Institute for
Public Policy Studies, 1207 18th Avenue South, Nashville, Tennessee
37212; e-mail: susan.han@vanderbilt.edu.
icant levels of emotional and behavioral problems (e.g.,
Lavigne et al., 1996).
Early emotional and behavioral problems have sig-
nificantimplicationsforyoungchildren,astheseproblems
often interfere with the acquisition of age-appropriate
skills and adversely affect developmental trajectories. For
instance, preschool children who have developed opposi-
tional or aggressive coping styles at home often continue
to use these coping styles when they enter school; of-
ten, these behavioral styles lead first to rejection by peers
and teachers who find this behavior aversive (Patterson &
Stoolmiller, 1991) and then to a negative cycle of social
and academic failure (Fergusson, Lynskey, & Horwood,
1996). Chronic externalizing problems in the preschool
years increase the risk for aggressive behavior and delin-
quency in middle childhood (Campbell, 1995; Prinz &
Connell, 1997), with the severity of behavior problems
tending to increase as children get older (Lavigne et al.,
1998). Hence, rather than “growing out” of these prob-
lems, for many children early problems remain stable or
even intensify as the children become older.
681
0091-0627/05/1200-0681/0 C ?2005 Springer Science+Business Media, Inc.

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682Han, Catron, Weiss, and Marciel
One potentially useful approach to intervening with
preschool-age children may be through classroom-based
behavioral programs targeting children’s social and
problem-solving skills. School-based programs have a
number of advantages, including increased access to
children and the opportunity to work directly in a pri-
mary environment of the children, the school (Catron &
Weiss,1994).Severalstudiesofsocial-cognitiveproblem-
solving skills training for preschool children suggest that
classroom-based intervention can significantly improve
young children’s abilities to generate alternative solutions
for interpersonal conflict situations (Shure, 1997; Shure
& Spivack, 1980), increase their positive social behav-
iors (Denham & Burton, 1996) and cooperative behavior
(Doescher & Sugawara, 1992), and reduce their nega-
tiveemotionalreactionsandbehaviorproblems(Brigman,
Lane, Switzer, Lane, & Lawrence, 1999; McKinney &
Rust, 1998). These studies are, however, limited by var-
ious methodological shortcomings, including lack of a
control group (McMahon, Washburn, Felix, Yakin, &
Childrey, 2000), failure to assess children’s behavior
problems as an outcome (Doescher & Sugawara, 1992;
Vaughn, Ridley, & Bullock, 1984), and small sample
sizes.Thus,theextenttowhichschool-basedprogramsfor
preschool children can prevent or reduce their aggressive
and disruptive behaviors and enhance their social skills
remains unclear.
It is encouraging, however, that among older chil-
dren (i.e., elementary school-age children), there is ev-
idence that classroom-based programs targeting behav-
ioral and social problems produce positive effects, with
small to moderate mean effect sizes across different types
of programs (Durlak, 1995; Wilson & Lipsey, 2000).
Classroom-based programs can be effective at increasing
students’ prosocial behavior and decreasing their aggres-
sive and disruptive behavior (e.g., Greenberg, Kusche,
Cook, & Quamma, 1995; Kellam, Rebok, Ialongo, &
Mayer, 1994), although outcome data are not entirely
consistent. In a controlled evaluation with second- and
third-grade children who received a teacher-implemented
social-cognitive skills training program, for instance, sig-
nificanttreatmenteffectswerefoundforstudents’aggres-
sive behavior as assessed by behavioral observations, but
effects for parent and teacher reports were not significant
(Grossman et al., 1997).
An important approach to behavioral interventions
for preschool populations is to use teachers as pro-
gram implementers. As central change agents with a
consistent presence in the classroom, teachers can pro-
mote children’s positive development and generalization
of positive skills through their ability to provide chil-
dren with frequent opportunities to practice new skills
(e.g., Hawkins, Von Cleve, & Catalano, 1991; Kellam
et al., 1994; Weissberg, Barton, & Shriver, 1997). How-
ever, there have been few studies of teacher-implemented
mental health programs with preschool children, but ev-
idence from these studies does suggest that interven-
tion programs implemented by the classroom teacher can
be effective in increasing young children’s social skills
(Brigman et al., 1999; Denham & Burton, 1996) and de-
creasing behavior problems (McKinney & Rust, 1998).
Thus, a model of providing behavioral interventions to
preschool children through the classroom teacher repre-
sents an important and potentially effective approach to
reducing or preventing children’s mental health-related
problems.
Although teachers represent an important avenue for
program implementation, training teachers in program
implementation is not a simple matter. The literature on
teacher training clearly indicates that one-shot workshops
and brief in-service training likely will be insufficient to
support the introduction and maintenance of complex
interventions, as problems inevitably arise as teachers
integrate a new program into the extant classroom cur-
riculum and environment; without support, teachers of-
ten revert to their old approaches when faced with new
challenges (Rose & Church, 1998). When program im-
plementation is teacher-based, a focus on teacher training
and ongoing consultation regarding program implemen-
tation appears to be critical for ensuring program fidelity
and enhancing child outcomes (see Han & Weiss, 2005).
For instance, in a study of two different types of teacher
consultation provided to preschool teachers implement-
ing a classroom social skills program, children whose
teacher received ongoing consultation on implementing
the social skills program exhibited increased levels of
cooperative play behavior compared to children whose
teacher had received consultation not focused on im-
plementation (Farmer-Dougan, Viechtbauer, & French,
1999).Althoughthisfindingwasbasedonasmallsample,
studies of behavioral consultation with teachers in regard
to instructional techniques have similarly shown that di-
rect training procedures involving modeling, rehearsal,
and feedback regarding intervention plans lead to higher
treatment fidelity (Rose & Church, 1998; Sterling-Turner,
Watson, & Moore, 2002). Moreover, performance feed-
back provided by a consultant regarding implementation
of behavioral plans has been found to increase teacher use
oftheinterventionprogramandimprovetreatmentfidelity
(Mortenson&Witt,1998;Noell,Witt,Gilbertson,Ranier,
& Freeland, 1997; Witt, Noell, LaFleur, & Mortenson,
1997). Consequently, mechanisms built into an ongoing
supervision process that promote teachers’ implementa-
tion skills appear to increase the likelihood of accurate

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Teacher Consultation and Pre-K Social Skills Training 683
program implementation and also program maintenance
without the consultant’s continued presence (Leach &
Conto, 1999; Sterling-Turner et al., 2002).
The purpose of the present study was to evaluate the
efficacy of a pre-kindergarten intervention program based
on a teacher-consultation model, in which teachers are
supported in their implementation of the classroom pro-
gramthroughongoingin-classroomconsultationtoensure
correct implementation and adaptation (see Han & Weiss,
2005).Theinterventionprogramusedinthepresentstudy
was a modification of the RECAP program (Reaching
Educators, Children, and Parents; Weiss, Harris, Catron,
& Han, 2003), which is a semi-structured, school-based,
cognitive-behavioral and social skills training program
initially developed for elementary school children with
internalizing and externalizing problems. In a controlled
study with fourth-grade children selected for the presence
of co-occurring internalizing and externalizing problems,
childrenassignedtotheoriginalRECAPprogramdemon-
strated greater rates of improvement over a 20-month
assessment period than children in the control group in
regard to both internalizing and externalizing problems
(Weiss et al., 2003).
The pre-kindergarten RECAP program (Han, 2001)
was developed as a universal intervention program be-
cause of the need for a classroom-based program that pro-
vided teachers with the structure and materials to address
preschool children’s emotional and behavioral problems
and promote their prosocial skills development. Pre-K
RECAP includes (a) a classroom-based curriculum and
behaviormanagementsystem,bothofwhicharedesigned
to enhance children’s social skills and adaptive problem-
solving;(b)weeklysite-basedteachertrainingandconsul-
tation on implementation throughout the academic year;
and (c) a bi-weekly parent group component. The goals
of the program are to increase children’s social skills and
reducetheirinternalizingandexternalizingproblems.De-
livered by teachers for one academic year, RECAP em-
phasizes the remediation of children’s skills deficits at
both the cognitive and behavioral levels, and focuses on
training in social skills, affect regulation (e.g., awareness,
labeling, and monitoring of affect), and problem-solving.
The parent and teacher components of the program em-
phasize positive reinforcement, appropriate use of neg-
ative consequences, clear communication and expecta-
tions, and strengthening of adult–child relations. Using
pre- and post-treatment data collected from parents and
teachers in the fall and spring of the academic year, the
present study evaluated the effects of the pre-K RECAP
program on children’s behavior, as an initial investigation
of the value of an intensive teacher-consultation interven-
tion model.
METHOD
Participants
Selection, Enrollment, and Assignment
of Participants to Condition
Participants were selected from 12 pre-kindergarten
classrooms in 6 public elementary/middle schools that
serve children from low-income backgrounds (i.e., in all
schools, greater than 60% of students were enrolled in the
federal free and reduced-price meal program). Because
of the possibility that the intervention program might in-
fluence comparison group classrooms in the same school
(via informal teacher discussions, etc.), random assign-
menttothetreatmentorcomparisonconditionoccurredat
the school level. Three schools containing six classrooms
were assigned to receive the intervention program and
three schools containing six classrooms were assigned to
the comparison condition.6All children in the treatment
and comparison classrooms were eligible for participa-
tion.Atthebeginningoftheschoolyear,schoolpersonnel
contacted families, informed parents or guardians (here-
after referred to collectively as parents) about the project,
and requested permission to provide their names and tele-
phone numbers to the research project. Families who pro-
videdpermissionwerecontactedbyprojectstaffandwere
givenmoredetailedinformationabouttheproject.Written
informed consent for participation was obtained during
the initial interview, which occurred either at the home or
the school.
Participant Characteristics
Of the 220 children (aged 4–5 years) in the
12 participating pre-kindergarten classrooms, 166 (75%)
children and their parents were recruited for participation
in the study and completed the pre-treatment assessment.
The final evaluation sample included 149 children and
their parents who provided both pre- and post-treatment
data, which were collected in the fall (September and
October) and spring (April and May), respectively, of the
academic year. Table I presents the demographic char-
acteristics of this sample. The mean age of the children
was 4.4 years (SD = 0.3), and 56% were female. Re-
flecting the neighborhoods in which the families resided,
6Although 13 classrooms were initially recruited, one of the teachers
assigned to the treatment condition who had agreed to participate sub-
sequently decided thatthe programwas incompatible with her teaching
style and withdrew from the project.

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684Han, Catron, Weiss, and Marciel
Table I. Demographic Characteristics of the Sample by Group
Comparison group
(n = 66)
Treatment group
(n = 83)
Overall
(n = 149)
Child’s age (in years, M with SD)
Child’s sex (% of girls)
Child’s race (%)
African American
Caucasian
Mixed/other
Parent’s age (in years, M with SD)a
Parent’s level of education (%)a
11th grade or lower
High school diploma
Some college
Bachelor’s or professional degree
Parent’s marital status (%)a
Never married
Married
Divorced
Separated
Widowed
Annual household income (%)b,c
Less than $10,000
Between $10,000 and $20,000
Between $20,000 and $30,000
Between $30,000 and $40,000
Above $40,000
Family structure (%)a
Living with two parents
Living with single parent
4.41 (0.30)
44.6
4.39 (0.30)
55.4
4.40 (0.30)
55.7
89.4
6.1
4.5
89.2
4.8
6.0
89.3
5.5
5.4
29.48 (8.07) 29.24 (7.08)29.35 (7.52)
18.5
26.2
43.1
12.3
26.3
34.2
31.6
7.9
22.7
30.5
36.9
9.9
67.7
21.5
4.6
4.6
1.5
67.1
19.7
5.3
5.3
2.6
67.4
20.6
5.0
5.0
2.1
30.8
23.1
20.0
15.4
10.8
49.3
21.9
12.3
8.2
8.2
40.6
22.5
15.9
11.6
9.4
43.1
56.9
34.7
65.3
38.6
61.4
Note. Percentages may not add up to 100 due to rounding.
aSample sizes are 65 and 76 for the comparison and treatment groups, respectively.
bSample sizes are 65 and 73 for the comparison and treatment groups, respectively.
cThe groups differed on annual household incomes, t(136) = 2.11, p < .05, with comparison group
families reporting a higher mean level of income (M = $18,100, SD = $13,900) than treatment
group families (M = $14,500, SD = $12,300).
theracial/ethniccompositionwas89%AfricanAmerican,
6% Caucasian, and 5% of mixed or other racial back-
ground. Parent informants were primarily mothers (80%),
followed by other female guardians (9%), fathers (8%),
and other male guardians (3%). Mean annual family in-
come was $16,200 (SD = $13,100).
Treatment and Comparison Groups
Comparison Group
A no-treatment comparison group was used. Chil-
dreninthecomparisonschoolswereassessedonthesame
schedule as the treatment group, but their classrooms re-
ceived no intervention from the project.
Treatment Group
The treatment group received the pre-kindergarten
RECAP (Reaching Educators, Children, & Parents; Han,
2001; Weiss et al., 2003) program, which provided (a) a
classroom behavior management system and a teacher-
administered social skills training curriculum delivered
to the classroom; (b) site-based teacher training and con-
sultation in the administration of the classroom program
and behavior management system; and (c) group parent
training conducted by a program consultant. The class-
room program provided training for children in (a) social
skills (e.g., making and keeping friends); (b) affect recog-
nition and expression; (c) re-attribution training (e.g., for
hostile attributions); (d) self-monitoring and self-control
skills; (e) problem-solving skills (e.g., evaluating goals
and consequences of behavior choices); and (f) relaxation

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Teacher Consultation and Pre-K Social Skills Training685
strategies. The classroom curriculum was adapted for
the pre-kindergarten level from the original fourth-grade
RECAP lessons and incorporated some materials (e.g.,
puppets, pictures) from a commercially available pro-
gram, Second Step for the preschool level (Committee
for Children, 1991). From September to May of the aca-
demic year, classroom lessons were taught by teachers
two to three times per week and were reinforced daily
by teachers throughout the school day using positive re-
inforcement tokens (friendly suns), teacher modeling and
mediation of problem-solving steps, and explicit discus-
sion of behavioral and affective consequences of behavior
choices. The aim of the classroom program was to help
students learn a common language and set of skills for
functioning adaptively, to in turn develop prosocial class-
room norms and expectations for children’s interactions
with each other.
Throughout the academic year, program consultants
spent one day (4–6hr) per week in each classroom for
ongoing training of teachers and teaching assistants in
weekly group meetings, observation of teachers’ pro-
gram implementation, and consultation on implementa-
tion. Topics for teacher training on the program included:
(a) understanding the reasons for children’s behavior (i.e.,
what factors are reinforcing the behavior); (b) estab-
lishing effective classroom expectations and structure;
(c) importance of and techniques for reinforcement of
students’ positive behavior; (d) use of consistent, fair, and
effective discipline; (e) adaptive communication skills;
(f) home-school communication; and (g) modeling adap-
tive problem-solving in naturally occurring situations.
While in the classroom, the consultant helped to reinforce
andmodeltheprogram’sprinciples,andprovidedteachers
andtheirassistantswithfeedbackontheirimplementation
of program strategies and techniques (e.g., helping teach-
ers to customize the program for the particular needs of
their classroom). Consultation focused on program im-
plementation to guide the teachers in administering the
classroom social skills curriculum correctly and tailoring
the behavioral management system to fit the needs of the
classroom.
Consultation served two primary functions. The
first function was to help teachers implement the pro-
gram accurately and consistently by (a) directly observ-
ing teachers’ implementation and students’ responses to
the program; (b) providing feedback on implementation
and collaboratively resolving implementation issues; and
(c) modeling program techniques. The second function
was to identify sources of positive reinforcement for
the teachers’ efforts at program implementation, in or-
der to promote teacher motivation. This was achieved
by (a) focusing teacher attention on incremental program
successes;(b) guidingteacherstoobjectivelyevaluateand
interpret the immediate or short-term effect of a par-
ticular program lesson or technique on their students;
and (c) helping teachers to make accurate attributions of
improved student behavior to teachers’ use of effective
techniques. Further elaboration of this model for provid-
ing intensive in-classroom teacher consultation to support
program implementation is discussed in Han and Weiss
(2005).
The pre-K RECAP program also included a parallel
component for parents (Weiss, 1998) that was aimed at
enhancing parents’ skills in (1) establishing clear expec-
tations for prosocial behavior; (2) using positive and neg-
ativeconsequencesthatconsistentlyreinforceappropriate
behaviorsandeffectivelydiscourageinappropriatebehav-
iors; (3) reinforcing children’s use of “friendly skills” at
home and school; (4) assisting their children to “stop and
think” about their behavior choices and consequences;
and (5) communicating more effectively with teachers
about their children’s behavior and educational program.
The parent training component was administered by the
program consultant and was offered to parents of children
in the treatment classrooms in a group format with 16
bi-weekly sessions at the school. However, parent atten-
danceatthesemeetingswasverylow,withlessthan5%of
parents in the treatment group attending any of the meet-
ings. Hence, the implementation of the parent component
was not successful, despite the consultants” attempts to
maintain ongoing communication with parents through
newsletters, personal contact, etc.
Consultant Training, Supervision, and Maintenance
of Treatment Fidelity
Two masters-level clinicians served as the program
consultant to teachers and the group leader for the parent
groups. Consultant training was provided by Susan Han
and Bahr Weiss, developers of the RECAP and pre-K
RECAP programs. Consultants first read program man-
uals and related materials and then participated in train-
ing sessions regarding the conceptual and clinical back-
ground of the program and the rationale and importance
of staying within the framework of the program. Train-
ing also was provided regarding what forms of flexibility
are acceptable within the model (e.g., different forms of
positive reinforcement may be used by teachers, as long
as the positive reinforcement is administered appropri-
ately), and how to handle clinical issues within the frame-
work of the model (e.g., teacher resistance to providing
high rates of positive reinforcement). To review program
implementation and maintain treatment fidelity, the pro-
gram developers periodically visited the classrooms to