Culturally Adapted Precision Education Approach Based on MTSS For Externalizing Problems in Chinese Schools

• In Event: Poster Session 10
  In Poster Session: PS 10 Topic - Prevention and Interventions

Abstract

Introduction:
Externalizing behavioral problems interfere with academic outcomes and learning environment, which persist as a time/resource-consuming issue in Chinese schools (National Mental Health Act, 2011). Local researchers supported the efficacy of certain behavioral interventions originated from the Western literature, but their implementation in highly populated Chinese schools are uncoordinated with dubious cultural compatibility, feasibility, and acceptability.
The Multi-Tiered System of Support (MTSS) provides prevention and intervention services to students through a tiered continuum of supports to match the level of each student’s need (VanDerHeyden, 2006). The cost-effectiveness and universality of MTSS makes it a promising model to deliver behavioral interventions in Chinese schools.
Nevertheless, the existing “one-size-fit-all” approach undermined the effectiveness of school-based interventions for the diverse needs of students in China. Concerned with examining "what intervention worked with whom and how did it work", the Precision Education Approach (PEA, e.g., Student Intervention Matching System (SIMs); Miller et al, 2018) offers significant promise to ensure optimized outcomes by strategically matching and tailoring behavioral interventions to individual and contextual characteristics (Cook et al., 2018).
Given the unique characteristics of Chinese schools (e.g., extreme student-teacher ratios, students’ diverse needs, limited resource and psychological professionals), there is a pressing need for a cost-effective, precision-focused, and culturally compatible mental health service delivery model. The current study proposed and preliminarily tested a culturally adapted precision education approach implemented within MTSS at a public elementary school in Central China.
Methods:
Six students evenly selected from three classrooms with externalizing behavioral problems were randomly assigned to three mixed multiple baseline designs (across participants and settings). Following the tiered process of MTSS, three teachers implemented universal screening and PEA in consultation with the researchers using SIMs adapted for education settings and culture in China.
Procedure:
A brief group training (45 minutes) for participating teachers reviewed MTSS and PEA focusing on how to implement with fidelity. The teachers used a two-gate screening approach (nomination followed by a brief screener) to identify students at-risk for externalizing problems. Then they used SIMs to match students to specific interventions and modified intervention content and implementation to comply with Chinese educational context and culture. The teachers implemented interventions, collected progress monitor data, and self-checked fidelity regularly. After two weeks, data-based decisions were made. Acceptability, feasibility, and cultural compatibility were evaluated via interviews with teachers and students.
Results:
Visual analysis supported the efficacy of ATI within MTSS across the six students and three settings, which was corroborated with effect sizes using Percentage Exceeding Median (PEM) and the Non-Overlap of All Pairs (NAP) (Figure and Table 1; Parker et al., 2011). All participants favorably rated PEA in MTSS as acceptable, feasible and culturally compatible.
Conclusion:
The Precision Education Approach within MTSS, which was strategically adapted to Chinese educational system and culture, proves to be a promising approach to address the long-lasting externalizing problems in Chinese schools. The findings inform practitioners and researchers on how to translate Western originated behavioral services for students from other cultures, with attention to its effectiveness, cultural compatibility, and acceptability.

Author

• Yanchen Zhang, University of Iowa
  Presenting Author