1. School-based Intervention for K-2 nd Graders with Disruptive Behavior Disorders Jacob Venter, MD; Anne Marie Cardinal, LCSW; Melissa Shaw, LPC; Linda Wiskerchen, LCSW; Sara DeSimone, LCSW and Alicia Ledesma, LPC. District Medical Group, Inc. Research Questions  Assess changes in pro-social and antisocial behaviors in response to an intensive, school-based early intervention for students with classroom disruptive behaviors  Test the effectiveness of a research-based intervention in a primarily minority population of students with significant behavioral problems Introduction  The Incredible Years, Dinosaur Small Group Therapy Program, is an evidence-based program that can be delivered in a school setting. The program was developed by Dr. Carolyn Webster-Stratton of the University of Washington Parent Clinic. It is a SAMHSA Model Program that was awarded exemplary best practices by the Office of Juvenile Justice & Delinquency Prevention.  The current intervention used the small group program developed for children known as “Dinosaur School” with a blend of cognitive, affective and behavioral components. A friendly cadre of puppets assist in the delivery, which brings elements of play therapy into the intervention. “Dina” is the Dinosaur Principal of the program who visit regularly to engage the children in the intervention and provide opportunities for children to be noticed for good behavior by a Principal with distinction. Dina also encourages children in role playing activities, an important opportunity for behavioral rehearsal. Two other main puppets are the child-sized siblings Wally and Molly. Children identify with their friends who have similar problems with academics and behavior. They learn by teaching the puppets when they are overwhelmed by problems.  Major program segments of Dinosaur School include emotions, problem- solving, anger management, friendship, and school success skills. Each meeting consists of welcome and review of previous skills, video vignettes demonstrating new skills, role play rehearsal, descriptive play, an activity, chip trade-in, homework, and closing song. Methods  Teachers or parents referred K-3 rd graders due to difficult to manage, disruptive classroom behavior. Prior to the program and at completion, teachers rated behavior with the School Social Behavior Scales (3 subscales measure “social competence” and 3 subscales measure “antisocial behavior”).  The one-school year intervention consisted of the “Dinosaur School” Child Training Programs (Small Group Therapy) component of The Incredible Years, implemented by Master’s level therapists.  Teachers had 3 weeks with students to get to know them, then completed pre-tests after which the intervention began. Data were analyzed using paired t-tests to examine differences in mean scores before and after the intervention.  Each group had 6 students, one Master’s level therapist, and one MSW intern. Groups met twice a week for 65 minutes. Each group had review time, a vignette presenting new skills, role play, descriptive play activity, and reward time. Songs and opportunities to interact with puppets were important parts of engagement. Therapists sent video tapes to the Incredible Years for review. Results  Eighty-eight participants completed the study. Scores on all pro-social scales improved significantly (p<.001). Scores on all antisocial scales decreased significantly. Scores on the Antisocial Behavior and Defiant/Disruptive subscales decreased to a more significant degree (p<.001) than did scores on the Hostile/Irritable and Antisocial/Aggressive subscales (p<.01). Discussion The benefits of this school-based intervention support its implementation for disruptive behavior in schools. This model of intervention also provides effective ways to meet the needs of an underserved population. Children with significant needs for behavioral and social/emotional intervention can be treated in the same environment where the need is greatest: the community school. They can also receive the level of intensity of treatment needed to change patterns of behavior because the commitment to treatment is built into the commitment to education. The intervention has proven successful across diverse participants, as demonstrated by a separate analysis with age, gender, and ethnicity as variables. Special appreciation to David Drachman, Ph.D. and Gilbert Ramos, MA for their contributions with data management, preparation, and analysis. An NIH/National Center on Minority Health and Health Disparities Center of Excellence The Incredible Years – “Dinosaur School” Small Group Therapy Program SIRC is funded by a Center of Excellence grant from the National Center on Minority Health and Health Disparities NIH(P20MD002316-05).  When minority and non-minority ethnicity scores were compared, no significant differences were observed. Nonetheless, overall scale scores for each subgroup showed significant changes. Data Source  Dinosaur School was implemented in the Osborn School District, which serves an inner city, low income, multi-cultural, multi-lingual population. School demographics included 63% Hispanic,13% non-Hispanic Caucasian, 10% Native American/Alaskan Native, 11% African American, and 1% Asian/Pacific Islanders. Of these, 25% were considered limited in English or “English Language Learners.”  The school district consists of five elementary schools and one middle school in central Phoenix. Teachers provided pre- and post-intervention data by completing the School Social Behavior Scales. Conclusions The Small Group Therapy module of The Incredible Years program reduced disruptive behavior and increased pro-social behavior in children from K-3 rd grades. Although behaviors as measured by both scales improved, those assessed by two of the Antisocial Behavior subscales benefited less robustly or possibly needed longer intervention length for response. Further studies might focus on the effect of parent and teacher ability to change adult responses to children’s negative and defiant behaviors so as not to continue a cycle of reinforcement of these patterns. This intervention was implemented in a school district of typically underserved children. The data was analyzed in two stages: 1) to assess for significant changes in pro-social and antisocial behaviors from pre- to post-intervention, and 2) with isolation of demographic variables including age, gender, and ethnicity. When these results were broken down, intervention outcomes were the same. This program proved effective with a population of primarily minority children in a school district where 85% of the students are eligible for free and reduced lunch. This intervention, funded through a US Dept. of Education Elementary School Counseling Initiative, was a collaboration with the Osborn Elementary School District and District Medical Group of Arizona, Inc.  Student participants (N=88) were from grades K-3, between 5 and 8 years of age, and mostly male (n=72).  Participant ethnicity was largely minority: 2.3% Asian, 19.3% Black, 44.3% Hispanic; 10.2% Native American, and 23.9% White. Scale A: Social Competence Scale higher scores = higher social competence Scale B: Antisocial Behavior Scale lower scores = lower antisocial behavior PR: Peer Relations SubscaleHI: Hostile/Irritable Subscale SM: Self-Management/Compliance SubscaleAA: Antisocial/Aggressive Subscale AcB: Academic Behavior SubscaleDD: Defiant/Disruptive Subscale TimeScale A*PR*SM*AcB*Scale B**HI***AA***DD** Pre-79.735.125.219.591.538.525.627.3 Post-93.240.629.223.581.535.323.023.3 Post-test scores significantly greater than Pre (p<.0005), ** Post-test significantly lower than Pre-test (p<.0005), *** Post-test significantly lower than Pre-test (p=.002) TimeScale A*PR*SM**AcB*Scale B***HIAADD**** Pre-test Minority 78.834.824.919.191.738.925.527.3 Pre-test White 82.735.926.120.791.037.526.027.5 Post-test Minority 93.140.529.423.279.734.822.322.7 Post-test White 93.6.40.728.624.387.336.725.425.2 *Post-test scores significantly greater than Pre- (p<.0005) *** Post- significantly lower than Pre- (p=.015) **Post- significantly greater than Pre (p=.001) **** Post- significantly lower than Pre- (p=.004)