Analyze How Trauma Might Impact Learning in Educational Settings

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Consider the two journal articles attached that talk about about trauma and educational settings. Consider the different educational settings that you have experienced and how trauma might affect learning in those settings (I have only worked in the elementary school setting). Put together 2-page reflection about how trauma might impact learning across educational settings (middle and high school).

You can use three scholarly sources in addition articles attached.

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This reflection should exhibit evidence of concept knowledge and demonstrate thoughtful consideration of the content.

American Psychological Association 2014 Convention Presentation

Trauma and Mental Health As Barriers to Learning and Achievement for
Youth in Residential Educational Settings

Michelle V. Porche
Wellesley College

[email protected]

Kara Sabalauskas
Home For Little Wanderers

Heidi Ferreira
Home For Little Wanderers

Topic: 80 Trauma

The Report of the Surgeon’s General Conference on Children’s Mental Health (2000) revealed 1 in 5 children has a

mental disorder, and 1 in 10 suffers from severe mental illness, increasing the likelihood that they will do poorly in school

(Bagdi & Vacca, 2005). According to the Institute of Medicine (Reynolds, Chen, & Herbers, 2009), about 50% of students age

14 and older who drop out of high school have a mental disorder; 65% of boys and 75% of girls in juvenile detention have at

least one mental illness. Early adversity and trauma were found to be predictive of psychological disorders and school dropout

rates for a representative sample of emerging adults, and the association between trauma and dropout was mediated by

substance abuse and conduct disorder (Porche, Fortuna, Lin, & Alegria, 2011). Knowledge regarding the connection between

mental health and learning is growing, but still understudied.

Youth who have experienced adversity and trauma are overrepresented in residential educational settings. The focus on

therapeutic treatment in these settings is essential given the significant mental health concerns of students who have exhausted

opportunities in mainstream schools. There is limited research on risks and supports for the academic achievement of this

population. Thus, it is necessary to improve our understanding of barriers to learning in order to develop effective educational

strategies that can foster achievement. This study investigates prevalence of trauma experience for youth in residential settings

as a first step to understanding how PSTD symptoms inhibit capacity for learning.

Theoretical framework. Toxic stress (Shonkoff, Boyce, & McEwen, 2009) alters brain functioning and may contribute to

structural changes in the brain (Cohen, Mannarino, & Deblinger, 2006; Teicher et al., 2003; Weber & Reynolds, 2004).

Resulting changes in neurotransmitter activity affect psychobiological function (Bremner et al., 1994), for example, increased

hypervigilance limiting the amount of attentional resources that can be directed towards learning and staying on task. Caffo

and colleagues (2005) found that learning and attention disorders were common psychiatric problems for children and

adolescents following traumatic experiences.

Sample and Procedure. Students at two residential/educational sites serving grades 6 to 12 participated in the study

(n=135; 90% male; 47% White, 33% Black, 13% Latino, 7% other/unknown). Typically, students experience multiple

out-of-home and school placements and are diagnosed with DSM-IV disorders. Demographic information and the Adverse

Childhood Experience (ACE) score was collected through chart review. Clinical staff administered the 17-item CPSS (Foa, et

al., 2001) to assess PTSD symptoms.

Results. Students experienced parental separation/divorce (88%), threats/emotional abuse (76%), family member(s) with

mental illness (65%), feeling unloved by family (60%), family member(s) with substance abuse (58%), physical abuse (56%),

neglect (45%), family member(s) incarcerated (40%), and sexual abuse (32%). Most frequent symptoms of PTSD were

flashbacks and intrusive memories that affected sleep, anger, and concentration. Over half of students reported that symptoms

impacted schoolwork. Over 60% scored below average on reading comprehension.

Conclusion. This study lays a foundation to develop effective academic interventions within a clinical context for

residential students with multiple adverse childhood experiences.

T rauma-Informed Classrooms and Schools

B e y o n d B e h a v i o r

<- –

T r a u m a – I n f o r m e d C l a s s r o o m s a n d S c h o o l s

Brian C avanaugh, U niversity of M aine at Farmington

C hildhood emotional, physical,
and/or sexual trauma is a
common experience. Research

indicates that as many as 68% of
children experience at least some form
of trauma event (Pappano, 2014).
Although many children will not
experience post-traumatic effects of
such experiences, many students with
disabilities, particularly students with
emotional and behavioral disorders
(EBD) have experienced trauma such
as abuse or neglect (Jaudes & Mackey-
Bilaver, 2008; Milot, Ethier, St-Laurent,
& Provost, 2010). For example, in one
recent study of children in the child
welfare system it was found that the
most common disability present in
children with substantiated
maltreatment was emotional
disturbance (Lightfoot, Hill, &
LaLiberte, 2011). Furthermore, it is
estimated that about 30% of
adolescents with EBD have
experienced trauma or show signs of
post-traumatic stress disorder (Mueser
& Taub, 2008). Thus, teachers of
students with EBD need to be aware
of the impact of trauma on children
and the most effective ways to address
their educational and social needs.

The purpose of this article is to
discuss the nature of childhood
trauma with an emphasis on its
impact in educational settings. A
particular focus will be on multitiered,
research-based strategies for
supporting students who have
experienced trauma. I begin by
discussing the impact of trauma on
children, followed by a brief
description of trauma-informed
practice. The major emphasis of the
article is a discussion of specific
supports and interventions along with
additional considerations for
supporting implementation of
trauma-informed practices.

Trauma and its Effect on Children
in Schools

The American Psychological
Association (APA; 2015) describes
trauma as “an emotional response to a
terrible event.” The APA also indicates
that such trauma can lead to
challenges with emotional regulation,
social relationships, and the
development of physical symptoms
due to anxiety. Traumatic experiences
may include physical or sexual abuse,
neglect, experiencing or witnessing
domestic violence, exposure to
community and school violence,
natural or man-made disasters,
terrorism, suicides, and war.

Trauma can take many forms and
may involve the family, a community,
or even an entire nation. For example,
some communities and schools have
high rates of refugees who may have
experienced trauma in their native
country through violence, famine, or
displacement (e.g., Ellis, MacDonald,
Lincoln, & Cabral, 2008). Trauma can
relate to individual incidents (e.g.,
terrorism, school shootings) or day-to-
day life (e.g., abuse, neglect; American
Association of Children’s Residential
Centers, 2014).

Tragically, people often hear of
horrific tragic events in the news
media such as school shootings or
terrorism. Such events may be
traumatizing to children. As
damaging as these events can be,
most students, including a number of
students with disabilities such as
EBD, experience trauma (Jonson-Reid,
Drake, Kim, Porterfield, & Han, 2004;
Romano, Babchishin, Marquis, &
Frechette, 2014) through what has
been referred to as adverse childhood
experiences, or ACEs. A large study
conducted between 1995 and 1997
by the Centers for Disease Control
(Felitti et al., 1998) found that ACEs

are very common. ACEs include 10
different experiences grouped into
three overarching categories: abuse,
neglect, and household dysfunction.
Results from the ACEs study
indicate that roughly 64% of people
experience at least one ACE with
22% of the population experiencing
three or more ACEs. Table 1 provides
specific information about the
prevalence of each ACE. ACEs are
associated with a number of
deleterious outcomes including
significant health problems later in
life (e.g., obesity-related illnesses)
and early death.

More closely related to school-
based challenges, ACEs are associated
with social, emotional, and cognitive
impairment, engaging in high-risk
behaviors, disability, and social
problems (
violenceprevention/acestudy/), all of
which are common in students with
EBD (Walker, Ramsey, & Gresham,
2004). It has been found that the more
ACEs a child experiences (referred to
as an ACE score), the higher the like­
lihood of experiencing these negative
outcomes. These challenges can
manifest themselves in a number of
school-based academic and behav­
ioral challenges such as aggression,
attendance problems, depression,
inattention, anxiety/withdrawal, and
delayed language and cognitive
development (Lansford et al., 2002;
Veltman & Browne, 2001). Given the
common nature of ACEs and other
traumatic experiences and their direct
impact on educational progress of
students, it is critical that educators
engage in trauma-informed educa­
tional practices.

Trauma-Informed School Practices

While research and theory has
been put forth in the mental health

V o l . 2 5 , I s s . 0 2 , 2 0 1 6 41

T rauma-Informed Classrooms and Schools

Table 1 Types and P revalence of Adverse
Childhood Experiences

A d v e rs e
C h ild h o od P rev a le n ce

Experiences (p e rc en tag e )

Emotional abuse 10.6
Physical abuse 28.3
Sexual abuse 20.7

Emotional neglect 14.8
Physical neglect 9.9

Household dysfunction
Mother treated 12.7

Household 26.9

substance abuse
Household 19.4

mental illness
Parental 23.3

separation or

Incarcerated 4.7

and social services fields regarding
trauma-informed practices (Knight,
2015), the discussion of trauma-
informed practice in schools is less
common. This is somewhat troubling
given the finding that schools are
often the primary provider of mental
health services for children (Evans,
Stephan, & Sugai, 2014). Trauma-
informed practice is focused on
practice that, “encourages . . .
providers to approach their clients’
personal, mental, and relational
distress with an informed
understanding of the impact trauma
can have on the entire human
experience” (Evans & Coccoma, 2014,
p. 1). According to the National
Center for Trauma-Informed Care
(NCTIC, 2015), a trauma-informed
approach can be applied to a program,
organization, or system that

1. Realizes the widespread impact
of trauma and understands
potential paths for recovery;

2. Recognizes the signs and
symptoms of trauma in the

clients, families, staff, and others
involved with the system;

3. Responds by fully integrating
knowledge about trauma into
policies, procedures, and
practices; and

4. Seeks to actively resist
retraumatization (Substance
Abuse and Mental Health
Services Administration
[SAMHSA], 2014).

With the high prevalence of trauma
in school-age children and youth, it is
likely that many students who have
experienced trauma may not receive
special education services, including
support under the emotional
disturbance category. Furthermore,
“trauma-informed” is not just applied
to specific practices but, rather,
encompasses an entire organizational
structure and is reflected in its purpose,
policies, and mission (NCTIC, 2015).
Thus, trauma-informed practice should
focus on educational strategies across a
continuum of multitiered systems of
support (MTSS) such as school-wide
positive behavioral interventions and
supports (SWPBIS; Homer, Sugai, &
Anderson, 2010). Below are multitiered
supports that adhere to many of the
goals and principles of trauma-
informed organizations. These include
supports for student safety, positive
interactions, culturally responsive
practices, peer supports, targeted
supports, and strategies that support
the individualized needs of students.

Safety and Consistency
A key principle of trauma-

informed educational practice is the
development of a safe environment.
While safety is important for all
students, it is especially important for
students who have experienced
trauma. Many traumatic experiences
threaten a child’s safety (e.g., physical
abuse, witnessing domestic violence)
and it is important to avoid
retraumatizing victims. In systems of
SWPBIS, establishing a safe
environment is critical and often done
through the development, teaching,
and reinforcement of three to five
school-wide expectations (Horner

et al., 2010). For example, one school/
class-wide expectation might include
“be safe.” This would be taught and
enforced throughout the school.
Although this is a universal
intervention that has demonstrated
effects for all students (Horner et al.,
2010), having similar expectations
across school environments also helps
traumatized children’s need for
consistency (Pappano, 2014). Children
who have experienced trauma may
need additional supports to ensure
consistency in their environment
including advanced warnings for
transitions, reminders, or specific
information about changes in the
routine. For example, if students
normally transition from reading to
math but a field trip is occurring after
reading, students who have
experienced trauma may need
additional reminders or specific
prompts about changes in the

Positive Interactions
High rates of positive interactions

including behavior specific praise
statements are a common, evidence-
based universal strategy. Benefits of
high rates of praise statements include
improved academic engagement and
reduced behavioral difficulties
(Conroy, Sutherland, Snyder, Al-
Hendawi, & Vo, 2009). Research has
long indicated the need to increase
and maintain higher rates of positive
interactions for students with EBD,
particularly those who have
experienced trauma (Fisher, Gunnar,
Chamberlain, & Reid, 2000). Positive
interactions can include tangible
rewards, behavior specific praise
statements (e.g., “excellent job
following directions!”), or
noncontingent praise, which includes
general positive interactions with
students to create a welcoming
environment (e.g., “Great to see you
today, Ramon!”).

Culturally Responsive Practice
Trauma-informed schools also

need to be culturally sensitive and
responsive to the needs of the

42 B e y o n d B e h a v i o r

T rauma-Informed C lassrooms and Schools


S c r e e n in g T o o l

E x t e r n a l i z in g
B e h a v io r
P r o b le m s

In t e r n a l i z in g
B e h a v io r
P r o b le m s

Behavioral and Emotional Screening
System (BASC-2 BESS; Kam phaus &
Reynolds, 2007)


Strengths and Difficulties Questionnaire
(SDQ; Goodm an, 2005)


Student Risk Screening Scale (SRSS;
D rum m ond, 1994)


Student Internalizing Behavior Screener
(SIBS; Cook et a l , 2011)


Systematic Screening for Behavior
Disorders (SSBD; Walker, Severson, &
Feil, 2014)


Table 2 Purposes of Sample Screening T ools

diversity within its walls. Different
cultures have varied expectations for
gender roles, norms for adult-child
interactions, and behavioral norms in
different contexts (Sugai, O’Keeffe, &
Fallon, 2012). Because cultures may
vary significantly, it is important to
have regular contact with families and
ensure that school staff has at least
beginning knowledge of the mores
and norms of diverse cultures. For a
number of reasons, this is particularly
important for children who have
experienced trauma. For example, if a
child has been traumatized due to
experiences fleeing from a country
with significant civil strife, this
information can be used to avoid

Also, understanding the subtleties
of language across cultures is helpful.
Sugai et al. (2012) give the example of
a teacher stating “you didn’t push in
your chair” as causing behavior
management challenges in a class
where the teacher from a dominant
culture interprets this statement as a
command while the student interprets
it simply as a statement of fact. While
this could cause challenges for any
student from a cultural minority, it can
be even more challenging for students
who have experienced trauma, given
the potential increase in anxiety it may
cause when teacher and student
expectations are different.

Peer Supports
Peer supports in mental health

settings for children who have
experienced trauma often mean
having peers who have experienced
similar hardships working together to
address needs (SAMHSA, 2014).
Although a public school may or may
not pair children together for such
treatment, the use of peer supports
can be an excellent universal strategy.
Peer supports may include options
such as peer tutoring (Bowman-
Perrott et al., 2013), which places all
children, including children who have
been traumatized, into an
empowering leadership role. Peer
tutoring also provides structured
opportunities to interact positively
with peers in an academically
engaging manner. This can support
feelings of success and self-efficacy
which may be helpful during recovery
and, more generally, promote positive
development (Benight &
Bandura, 2004).

Targeted Supports
Targeted supports, often

implemented within MTSS/SWPBIS
systems as Tier 2 interventions, can be
helpful in addressing a number of the
social and behavioral challenges
experienced by children who have
been traumatized. A number of
supports and interventions targeted
toward students with more

challenging emotional and behavioral
difficulties are available. Within
systems of MTSS, supports including
screening, check-in/check-out (CICO),
and social skills instruction may be
particularly effective (Bruhn, Lane, &
Hirsch, 2014).

Screening is a systematic process
used to identify students at risk who
may benefit from additional support
(Oakes, Lane, Cox, & Messenger,
2014). Screening is an important
practice for any school when
implementing a multitiered system of
support. However, it is particularly
helpful for identifying challenges
often associated with traumatization
including aggression, defiance,
depression, and anxiety. Although
screening students found to be at risk
for EBD does not specifically identify
students who have been traumatized,
the screening process can be helpful
for identifying all students in need of
behavioral support, including a
number of students experiencing
challenges due to trauma. When
screening in a trauma-informed
school, it is important to have
processes that identify students who
have externalizing (e.g., aggression,
disruptions) ami internalizing (e.g.,
withdrawal, sadness, anxiety)
behavior problems, given that both
are associated with trauma. Table 2
contains a partial list of screening tools
that screen for various types of

Students identified for targeted
supports may receive one of a menu of
interventions to address their areas of
risk. One evidence-based intervention
that may benefit children exposed to
trauma is check-in/check-out (CICO;
Crone, Hawken, & Horner, 2010).
Briefly, CICO includes a student being
assigned a mentor, regular prompts
for expected behavior, positive adult
interaction including feedback on
progress towards meeting behavioral
expectations, and positive
reinforcement for meeting goals.
CICO may be beneficial to children
that have experienced trauma given
its focus on predictable, scheduled
check-ins and the scaffolding of a

V o l . 2 5 , I s s . 0 2 , 2 0 1 6 43

T rauma-Informed C lassrooms and Schools

positive and productive teacher-child
relationship (Crone et al., 2010).

Another intervention that may be
beneficial is social skills instruction.
Children who have experienced
trauma may struggle with a number
of social skills related to organization,
anger management, and problem
solving (van der Kolk, 2005). Effective
social skills instruction includes
explicit teaching, modeling, and
practicing elements, including
multiple opportunities to practice the
skill with feedback.

Individualized Supports
Students who have been

traumatized may exhibit a number of
challenging behaviors. The
multifaceted nature of these
challenges often makes such students
candidates for individualized
behavior support. Fortunately, there
are significant commonalities between
individualized behavior supports and
trauma-informed practice including
individualized planning, client voice,
empowerment, and family supports
(Eber, Breen, Rose, Unizycki, &
London, 2008). Individualized
supports are informed by data
collected from functional behavioral
assessments (FBA; Crone, FTawken, &
Horner, 2015). Completion of the FBA
includes determining the
environmental variables that predict
and maintain problem behavior. For
example, people or specific situations
that remind the student of their
traumatic experience may trigger a
student’s aggressive behavior in the
classroom. When these triggers are
identified, support plans can be
developed that remove or adjust these
antecedents (Crone et al., 2015). For
example, if a student exhibits
challenging behavior after hearing
loud noises like a fire alarm, a plan can
be put into place to alert the student to
when a fire drill is going to occur. Or,
the student can be removed from the
setting just before the fire alarm

In addition to function-based
supports for students with or at risk
for EBD who have been traumatized,

the NCTIC (2015) suggests that there
is a need to focus on student
empowerment, voice, and choice in
the process of individualized support
planning. These features can often be
found in wraparound supports.
Wraparound supports include family
collaboration and natural
environmental supports that focus on
the student/family’s strengths, assets,
and needs rather than the problem
(Eber et al., 2008). For example, rather
than focusing singularly on a
student’s poor peer interactions,
wraparound supports could be
designed around the student’s
particular interests and his or her
potential need for more positive
connections with peers.

Additional Considerations

In addition to practices across all
tiers, other organizational
considerations are helpful to consider
when supporting the educational and
social success of children who have
been traumatized. These include
issues related to strengths-based
approaches and vicarious
traumatization (American Counseling
Association, 2011).

Use of a Strengtlis-Based Approach
Although children exposed to

trauma face a number of educational
and social challenges, it is important
to identify strengths-based
approaches when working with
students with traumatic histories.
Many of the practices and assessment
strategies that are beneficial to
students with EBD, including those
that have been traumatized, focus
inordinately on the emotional/
behavioral deficits of the population
(e.g., depression, aggression, attention
problems). It is imperative that these
needs be addressed. However,
students also need to experience
significant moments of success during
their school day. Finding times for
students to showcase their strengths
and offering choices during the day to
provide opportunities for students to
engage their interests are also critical.

Some students that have been
traumatized currently live in the
environment where the trauma
occurred. For example, they may be
currently living with a family member
who is physically abusive. In such
instances, providing a safe, trusting
environment where students feel
successful can be just as powerful as
other evidence-based interventions
(NCTIC, 2015). Additionally, NCTIC
emphasizes the need for victims of
trauma to be empowered and have a
voice and say in the decisions made
about their lives. This is done through
collaborative planning that involves
both the child, as appropriate, as well
as the family. Providing such
empowering experiences is
particularly important when planning
individualized behavior supports
(Brown, Anderson, & De Pry, 2015).

Addressing Vicarious Traumatization
While much of our work as

professionals in trauma-informed
schools needs to focus on the unique
needs of children who have
experienced such hardships, it is also
important to address the needs of
adults who work directly with
children. One challenge that can be
accompanied with working with
children exposed to trauma is
vicarious traumatization. Vicarious
traumatization has also been referred
to as compassion fatigue, secondary
traumatic stress, or secondary
victimization (American Counseling
Association, 2011). Essentially,
vicarious traumatization occurs when
a professional working with children
exposed to trauma “experiences” the
trauma. According to the American
Counseling Association, vicarious
traumatization may include a
preoccupation with the traumatic
event(s), avoidance of talking or
thinking about traumatic events,
being in a persistent state of arousal,
losing sleep over children under one’s
care, anger, and difficulty discussing

Addressing vicarious
traumatization requires an awareness
of one’s internal emotional state and

44 B eyond B ehavi or

emotional self-monitoring. In the
absence of supports to address
vicarious traumatization and other
challenges associated with working
with children exposed to trauma,
professionals can succumb to stress,
burnout and, ultimately, leave the
field. Supports for educators can be
both informal and formal. Formal
mentoring programs can be utilized
as a form of emotional support and
guidance for implementing practices
(Israel, Kamman, McCray, & Sindelar,
2014). In a trauma-informed school,
typical teacher mentoring programs
could include components related to
trauma including professional
development. School-based clinicians
such as counselors, social workers,
and psychologists can also be helpful
with processing the emotional strain
that can come with addressing the
needs of traumatized children. These
professionals could be helpful with
individual or small group sessions
with teachers or through providing
training on various ways to deal with
the stress of teaching students with
challenging emotional and behavioral
needs. Book study or facilitated
workshops can also be helpful. For
example, a group of teachers could
read and practice the activities found
in Stress Management for Teachers
(Herman & Reinke, 2015). Such
resources provide coping strategies to
address the rigors of stressful
classroom experiences. Finally, it is
important for educators to increase
the amount of positive experiences
they have in their own lives,
particularly around teaching. It can be
helpful to celebrate the “small”
successes within a seemingly vast sea
of challenges.

Application of Trauma-Informed
Approaches in the Classroom

Mrs. Seeley is a classroom teacher in
a diverse community with a number of
students from various socioeconomic,
linguistic, and cultural backgrounds.
She has 25 students in her class and a
number have experienced trauma. She
begins each day by greeting her students

T rauma-Informed C lassrooms and Schools B ev o n d B e h a v io r


individually and positively as they walk
into the classroom. Upon the start of
class she reviews the behavioral
expectations, providing specific
examples of what expected behavior looks
and sounds like. Then, Mrs. Seeley
makes sure all students knozv the
schedule for the day, which is also posted
on the bulletin board. Additionally, she
spends an extra minute with Ellie, a
student who experienced abuse and was
recently removed from her home, to
remind her of her specific goals on her
CICO intervention and to provide
additional encouragement. Despite the
traumatic experiences, Ellie’s school
social, academic, and behavioral
functioning have improved since
beginning CICO because of the increased
structure, prompting, predictability, and
opportunities to build a more trusting
relationship with her teacher.

After a recent screening of students
for academic and behavioral risk, Mrs.
Seeley identified the need for additional
academic supports for several students,
including Abdidla, an English language
learner who spent several months in a
refugee camp. She has decided to
implement peer tutoring. Ellie is a strong
reader and is paired with Abdulla for this
intervention. This boosts Ellies
confidence and gives Abdidla additional
practice developing reading fluency and
vocabulary. Abdulla, a previously
withdrawn student, has begun
interacting more frequently with his

Mrs. Seeley is proud of her students
and feels she has created a safe,
responsive, proactive environment. On
days when she experiences frustration or
is emotionally triggered by one of her
student’s traumatic experiences, she takes
time to meet with the school counselor to
discuss the issue and also uses deep
breathing and meditation exercises to
avoid getting overwhelmed emotionally.
Mrs. Seeley has created a trauma-
informed environment in her classroom
and has incorporated her individualized
programming with the multitiered school-
wide supports in place for all students,
particularly students who have
experienced trauma.

American Association of Children’s

Residential Centers. (2014). Trauma-
informed care in residential treatment.
Residential Treatment for Children and
Youth, 31, 97-104.

American Counseling Association. (2011).
Vicarious trauma. Fact Sheet #9.
Internet site: http://www.counseling.
9—vicarious-trauma .pdf.

American Psychological Association.
(2015). Trauma. Internet site: www.

Benight, C. C., & Bandura, A. (2004). Social
cognitive theory of posttraumatic
recovery: The role of perceived self-
efficacy. Behaviour Research and
Therapy, 42, 1129-1148.

Bowman-Perrott, L., Davis, H., Vannest,
K., Williams, L., Greenwood, C., &
Parker, R. (2013). Academic benefits of
peer tutoring: A meta-analytic review
of single-case research. School
Psychology Revieiv, 42, 39-55.

Brown, F., Anderson, J. L., & De Pry, R. L.
(2015). Individual positive behavior
supports: A standards-based guide to
practices in school and community
settings. Baltimore, MD: Brookes.

Bruhn, A. L., Lane, K. L., & Hirsch, S. E.
(2014). A review of Tier 2
interventions conducted within
multitiered models of behavioral
prevention. Journal of Emotional and
Behavioral Disorders, 2 2 ,171-189.

Conroy, M. A., Sutherland, K. S., Snyder,
A., Al-Hendawi, M., & Vo, A. (2009).
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