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Social-Emotional Learning Foundations (SELF) is a K-1 curriculum merging social-emotional learning and literacy instruction to promote social-behavioral and academic self-regulation for students at risk for emotional or behavioral disorders (EBD). We provide findings from a three-year pretest-posttest cluster randomized efficacy trial to determine the effects of SELF versus business as usual. The sample included 359 children identified as at risk for internalizing (e.g., anxiety or depression) or externalizing (e.g., aggression or disruption) behavioral problems. Using a three-level model, we found significant positive effects related to social-emotional learning and general behavioral functioning, and significant moderation and direct effects of the internalizing versus externalizing dimension. We examine potential implications for future research to better serve students at risk, particularly for internalizing problems.