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Excerpt: Interventions that include a combination of behavioral and lifestyle modifications— including decreased caloric intake, specific aids to changing diet, increased physical activity, and treatment of binge eating disorders—have modest benefit with appropriate use (strength of recommendation [SOR]: A, based on multiple randomized controlled trials). Hypnosis can be used as an adjunct to behavioral therapy for weight loss (SOR: A, based on systematic reviews).

The impact of Computerized Physician Order Entry (CPOE) on the dependent variables of medication-order compliance and time to first dose of antibiotic was investigated in this quasi-experimental study of a naturally-occurring CPOE intervention. The impact of CPOE on compliance and time to first dose was assessed by comparing measures of these variables from the intervention site and a non-equivalent control before and during intervention phases. Medication orders placed using CPOE were significantly more compliant than paper-based medication orders (p<.001), and first doses of antibiotic ordered using CPOE were delivered significantly faster than antibiotic orders placed using the paper-based system (p<.001). Findings support previous research indicating the positive impact of CPOE on patient safety as well as justify and enable future interventions to increase CPOE adoption and use among physicians. Additionally, data collected in this study will be used to provide behavior-based feedback to physicians as part of CPOE adoption and use intervention strategies to be explored in the forthcoming research. / Master of Science

Positive Behavioral Interventions and Supports (PBIS) frameworks, formerly known as effective school-wide discipline, started in 2005 as a State initiative to help raise student achievement by addressing the overlapping relationship between classroom conduct and academic achievement (Virginia Department of Education, 2009, superintendent's message). Positive Behavioral Interventions and Supports implemented as part of the effective school-wide discipline practices in the Commonwealth of Virginia are seeing strong reductions in referrals and student exclusions/suspensions from school (Ciolfi, Shin, and Harris, 2011). Over 90,500 individual students were suspended or expelled from a Virginia school in 2010-2011; many of them more than once (2011 p.1). As paradigms switch from reactionary to prevention, school-wide approaches to discipline utilizing Positive Behavioral Interventions and Supports are becoming more frequently used as a tool to reduce the number of office discipline referrals (ODR) and to keep students in class. Since the state has now 223 schools supporting the PBIS framework from 43 different school divisions, a study of the principles and practices of the most successful high school implementations could help high schools which are struggling with managing student conduct issues. By providing a compilation of those principles and practices that school leaders utilized to implement a highly effective Positive Behavioral Intervention Process, schools could focus on them to more successfully incorporate Positive Behavioral Interventions and Supports frameworks in their high schools. Three questions guided the work for this study. First, were there specific principles that the high schools using Positive Behavioral Interventions and Supports operated by to successfully implement and reduce office discipline referrals? Secondly, were there certain practices that these high schools also employed which garnered success? Lastly, what artifacts could the successful schools provide demonstrating their successful implementation of Positive Behavioral Interventions and Supports framework that would provide benefit to beginning or struggling high schools implementing Positive Behavioral Interventions and Supports? A qualitative study was used utilizing the grounded theory method and cross school comparisons of data. Interviewing superintendent-designated leaders from nine high schools that reduced office discipline referrals (ODR), uncovered the principles and practices common to the successful high schools employing Positive Behavioral Interventions and Supports. There were twelve interviews: three group interviews with 2 respondents each and nine individual interviews. The twelve interviews involved 15 people: • four division-level personnel: three were division leaders who were also PBIS Division Coaches and one who was titled PBIS Division Coordinator • eight school administrators (five principals and three assistant principals) • three teachers who also were designated as PBIS School Coaches No interviewee designated by the superintendent refused to be interviewed. Reviews of the data collected were analyzed across all divisions to report these principles and practices. These principles and practices could be shared with new high schools to consider prior to Positive Behavioral Interventions and Supports framework programs being implemented. As more high schools employ Positive Behavioral Interventions and Supports and are studied regarding reducing the number of office discipline referrals, the Commonwealth of Virginia's Department of Education can utilize these longitudinal data to craft more effective support for the programs across the Commonwealth of Virginia. All data were extracted from the recordings and then charted for common elements. Three principles emerged that led to the theoretical propositions those high schools that reduced ODR had: 1. PBIS Leaders who created a minimal set of school-wide rules. 2. PBIS leaders who believed improving school climate for staff learners improved student behaviors. 3. PBIS leaders who asserted that all school staff must be consistent with application of rules. Additionally the data reviewed were analyzed and the researcher discovered that high schools that reduce office discipline referrals (ODR) have common practices where: 1. PBIS leaders recognized positive behaviors and defined the expectations to the school. 2. PBIS leaders involved other learning community members and empowered students. 3. PBIS leaders analyzed and disaggregated data to inform their procedures. 4. PBIS leaders trained staff members and promoted school expectations. Additionally the data collected from the 12 interviews had respondents stating the single greatest obstacle that they encountered while implementing PBIS to reduce ODR which led to more implications for practice. Thus, the following lists the top obstacles that all respondents referred to in their interviews: 1. Nine interviews had respondents who listed the top obstacle as establishing consistency in both staff participation and rule application. 2. Six interviews also had respondents that listed finding time to implement PBIS strategies and interventions was their greatest obstacle. 3. One interview had a respondent who also stated finding funding was his main obstacle. Providing these data enabled high schools interested in implementing PBIS to be aware of these obstacles so those schools may avoid the pitfalls encountered as high schools employed PBIS frameworks to reduce ODR. However, all twelve interviews were noted with success stories that respondents felt were directly related to their reduction of ODR. 1. Six interviews had respondents that reported enhanced relationships between students, teachers, and administrators (within the school). 2. Seven interviews had participants that described how student successes enhanced school pride and school promotion. 3. Three interviews had respondents that discussed the improved relationships with community partners and parents. / Ed. D.

The purpose of this study was to explore regular education student perceptions of the effects of implementing behavioral interventions for seriously emotionally disturbed students (SED) in the regular classroom. Student perceptions of classroom friction or disruptiveness, apathy, and general enjoyment or satisfaction were evaluated. It was predicted that regular education students would report more classroom friction, increased apathy, and less satisfaction when interventions were implemented in the regular classroom for a target SED student.

Background: Behavioral interventions and evidence based guidelines along the cancer control continuum can reduce the burden of cancer. Objectives: This dissertation aims to increase our understanding of colorectal cancer screening (CRCS) decisional conflict and breast cancer survivorship care. This project: 1) assesses CRCS decisional conflict in a general population, 2) uses the Theory of Triadic Influence to model and evaluate direct and indirect associations between CRCS decisional conflict and colonoscopy adherence, 3) assesses post-treatment breast cancer care. Methods: Data from a questionnaire administered to randomly selected adults, 50-75 years, living in six MN communities (N=1,268) and the 2010 Behavioral Risk Factor Surveillance System (BRFSS) (N=1,024, women ages 27-99) were used. Multivariable logistic regression was used to identify characteristics associated with high CRCS decisional conflict; then structural equation modelling (SEM) was performed to assess direct and indirect associations of CRCS decisional conflict and colonoscopy adherence. Using BRFSS data, multivariable logistic regression was performed to assess the association between years since diagnosis and the type of clinician providing the majority of care for breast cancer survivors after treatment completion. Results: Greater colonoscopy barriers (OR=1.04; 95% CI: 1.02-1.05) and CRCS-specific confusion (OR=1.12; 95% CI: 1.10-1.15) as well as a healthcare provider not discussing CRCS options (OR=1.67; 95% CI: 1.18-2.37) were associated with increased odds of high CRCS decisional conflict. A similar relationship was found in the SEM analyses: both greater levels of perceived colonoscopy barriers and CRCS confusion were associated with higher decisional conflict (standardized total effects=0.42 and 0.39, respectively, p-values < 0.01). CRCS decisional conflict was associated with increased non-adherence to colonoscopy. This relationship was mediated by CRCS-specific self-efficacy and intention (standardized total effect=0.14, p-value <0.01). Among breast cancer survivors, women 0–1 and 2–3 years since diagnosis were 2.1-2.6 times more likely to have a cancer-related clinician providing the majority of care compared to women 6+ years since diagnosis (95% CIs: 1.0-4.3; 1.4-4.6). Conclusions: Decreasing colonoscopy barriers and CRCS-specific confusion could decrease CRCS decisional conflict and ultimately increase CRCS uptake. National policies to move breast cancer follow-up care to a primary care provider might be well-received by cancer survivors.

Teachers’ Perceptions of Using Positive Behavior Interventions and Supports as Behavioral Interventions in a Pre-K-5 Elementary School: A Phenomenological Study by Meghann E. Roberts-Clawson This qualitative study addresses teacher perceptions of using positive behavior interventions and supports (PBIS) as positive behavioral interventions. This phenomenological study was conducted within a Pre-K-5 elementary school in northwestern North Carolina. In order to collect qualitative data, personal individualized interviews were conducted from a purposeful sample of teachers in the school who have experience implementing more intensive positive behavioral interventions. By analyzing data derived from the interviews and classroom and individualized documentation, the researcher was able to identify themes such as teachers’ perceptions in regards to using PBIS as a behavioral intervention. Themes elaborating on the ways that teachers implement PBIS in their classroom as well as the most consistently used elements of the PBIS framework also emerged from this study. Findings from this study will be useful in helping to implement the PBIS framework to fidelity as well as helping to sustain these practices. This information will be vital in training new teachers that join the staff as well as veteran teachers who are struggling with individual students’ behavior.

This study evaluated the influence of academic, behavioral, and sociocultural variables on the implementation of Schoolwide Positive Behavior Support (SWPBS), a system intended to improve discipline in school buildings. The number of schools that are implementing SWPBS has been increasing dramatically over the years as school violence continues to rise and solutions are needed to improve school climate. This study examined the relationship between three categories of variables and the level of implementation of SWPBS in three multiple regression analyses. The categories were school demographic variables (i.e., ethnicity, socio-economic status, teacher: student ratio, percentage of teachers who are out-of-field), severity of need for change (suspensions, office referrals, percentage of students below grade level in reading), and team process variables (coaching, team functioning, administrative support). Of these variables, team functioning was the only one found to be sign ificantly related to implementation. A second component of the study involved collecting data relating to factors that were enablers or barriers to the implementation of SWPBS. Two-hundred and thirty-six school personnel completed a survey, Schoolwide Implementation Factor Survey (SWIF). The survey derived three factors through a factor analysis: school, staff, and students; principal; and assistant principal. These factors were all found to have a high Cronbach's alpha for internal consistency. There were significant differences between schools with a high, middle, and low level of implementation on all of these factors, with respondents from high implementing schools scoring the highest on all factors,and respondents from low implementing schools scoring the lowest. The item on the survey rated as the most helpful in the implementation process was "Expectations and rules that are clearly defined," while the item rated as the most problematic in the implementation process was "Adequat e funding for PBS." Overall, the results highlighted the complexity of implementing a system-wide change.(i.e., ethnicity, socio-economic status, teacher: student ratio, percentage of teachers who are out-of-field), severity of need for change (suspensions, office referrals, percentage of students below grade level in reading), and team process variables (coaching, team functioning, administrative support). Of these variables, team functioning was the only one found to be significantly related to implementation. A second component of the study involved collecting data relating to factors that were enablers or barriers to the implementation of SWPBS. Two-hundred and thirty-six school personnel completed a survey,Schoolwide Implementation Factor Survey (SWIF). The survey derived three factors through a factor analysis: school, staff, and students; principal; and assistant principal. These factors were all found to have a high Cronbach's alpha for internal consistency. There were signific ant differences between schools with a high, middle, and low level of implementation on all of these factors, with respondents from high implementing schools scoring the highest on all factors,and respondents from low implementing schools scoring the lowest. The item on the survey rated as the most helpful in the implementation process was "Expectations and rules that are clearly defined," while the item rated as the most problematic in the implementation process was "Adequate funding for PBS." Overall, the results highlighted the complexity of implementing a system-wide change.

The Check in/Check out (CICO) strategy is a secondary tier intervention designed to address those students who are not responsive to universal tier, school-wide positive behavioral interventions and supports (SW-PBIS), and require more targeted support. The present study extended the implementation of the CICO strategy to a residential facility. In addition, the study sought to determine the relationship between the maintaining function of behavior and responsiveness to CICO when a functional behavior assessment was conducted prior to the implementation of CICO. Six students with emotional and behavioral disorders (E/BD) in a residential setting participated in the study; three with attention-maintained behavior and three with escape-maintained behavior. Results of a nonconcurrent multiple baseline across participants design indicate that the mean total composite percentage of problem behavior improved for all three students with attention-maintained behavior, and the effect of the intervention generalized to the second most problematic classroom for two out of three. Further support of effectiveness of the intervention for attention maintained behavior is percentage of all non-overlapping data (PAND) of 90% or higher for two of three students. The mean total composite percentage of problem behavior for students with escape-maintained behavior improved for all three students, with a moderate change noted for Kevin. Only one student demonstrated generalization of effect in the second most problematic classroom and PAND above 90%. Future directions and limitations of the research also are addressed.

Check, Connect, Expect (CCE) is a secondary tier behavioral intervention for at-risk students who require targeted behavioral support in addition to school-wide positive behavioral interventions and supports. A full-time coach in the CCE intervention provided behavioral supports including daily check-in and check-out procedures, as well as targeted social skills instruction. This study extended CCE to a self-contained elementary school for students with emotional and behavioral disorders. Twenty-two students participated in the 17-week study that involved a four week baseline phase, followed by a 13-week intervention phase. The following research questions were addressed: (a) How did CCE affect student behavior?; (b) How did CCE affect student weekly academic engagement?; (c) How did CCE affect student weekly math calculation and oral reading fluency growth?; (d) How did severity of behavior predict student response to CCE?; (e) How did function maintaining the behavior predict student response to CCE?; (f) How did relationship strength with the coach predict student response to CCE?; and (g) How socially valid was CCE for teachers, paraprofessionals, and students? Two growth curve models were used to analyze the academic and behavioral data. Overall, students displayed significant behavioral growth during the intervention phase and positive growth in the areas of academic engagement and achievement. Severity of behavior, function, and relationship strength were not significant predictors of student response to the CCE intervention. Future directions, limitations, and implications for practice are discussed.