A multi-tiered system of supports offers a comprehensive model for the prevention of academic and behavior problems in schools. To date, research has emphasized the impact of universal and intensive interventions. However, the need for research on secondary or targeted group interventions (Tier 2) for those students who do not respond to the universal level of support is growing. This study evaluated CICO, a Tier 2 intervention, in improving student behavior when it is used with three elementary students from a high-need population and in conjunction with student accountability tracking, designed to promote parental involvement. Functional assessments indicated that all three students had attention-maintained problem behavior during instruction sessions. The study employed a concurrent multiple baseline design across students to assess the effects of CICO and CICO with accountability tracking on academic engagement and problem behavior. Results indicated that the team members were able to implement CICO with fidelity and their implementation of the intervention was effective in increasing academic engagement and reducing problem behavior. The CICO with accountability tracking implementation with one student contributed to further improvement of his target behaviors. These effects were shown to be maintained moderately well for two students who underwent fading. Results are discussed in terms of the study limitations and implications for practice and future research.

An educational framework known as School Wide Positive Behavior Support being implemented in school systems across the country provides the schools with three tiers of support to address both academic and behavior challenges. The purpose of this study was to evaluate the use of peer tutors when applied to a Tier 2 intervention known as Check-In Check-Out (CICO). Peer tutors performed the morning check-in with the tutees by setting the expectations for the day and giving the tutees their Daily Progress Report (DPR) form. Throughout the day, the tutees took the DPR form to each class where they received a score from the teacher. At the end of the class period, the peer tutors provided the tutees with feedback on the scores received on the DPR form. Once the school day finished, the peer tutees checked-out with the tutors and received a reward if they met their percentage goal. The results of this study showed that CICO implemented by peers improved classroom behavior for all three participants.

Contexte : Chez les adolescents, les troubles de santé mentale sont fréquemment associés à des troubles liés à l’usage de substances psychoactives. Ce double diagnostic complique le traitement et le pronostic des patients, en entraînant par ailleurs des coûts effarants pour la société. Selon la récente littérature ainsi que les priorités que les gouvernements fédéral et provincial de la santé se sont fixés, une approche intégrée des soins est celle à privilégier dans la prise en charge globale des troubles concomitants. Trois études randomisées contrôlées ont démontré qu’une intervention ciblée à certains profils de personnalité à haut risque de problèmes de consommation (Désespoir/Pensées négatives, Impulsivité, Sensibilité à l’anxiété, Recherche de sensations fortes), et prédisposant également à des troubles psychiatriques, réduit la consommation excessive d’alcool, la quantité et la fréquence de consommation ainsi que les problèmes liés à celle-ci. Dans ce mémoire, il a été postulé qu’une intervention brève ciblée à des facteurs de risque communs aux troubles concomitants, soit ces différents profils de personnalité, et visant la prévention et la réduction de la consommation et problèmes associés aurait aussi un effet bénéfique chez une population clinique psychiatrique d’adolescents. Méthode : Pour tester cette hypothèse, deux études ont été conduites dans le cadre de ce mémoire. Dans la première, ce sont des données d’une cohorte déjà existante d’adolescents en milieu scolaire qui ont été analysées afin de déterminer si parmi ces adolescents, ceux à haut risque de problèmes de consommation et présentant des symptômes de problèmes psychiatriques pourraient bénéficier de cette intervention brève. La même intervention a ensuite été testée auprès d’un échantillon d’adolescents en milieu clinique; cette étude, qui constitue la deuxième partie de ce mémoire, s’est déroulée au sein d’un département psychiatrique en centre hospitalier. Résultats : La première étude a permis de démontrer que les adolescents à haut risque de problèmes de consommation présentant des symptômes dépressifs et anxieux bénéficiaient tout autant de l’intervention. Ceux présentant des symptômes d’hyperactivité/impulsivité et problèmes de conduite en ont quant à eux bénéficié autant sinon davantage, les effets étant d’ailleurs plus prononcés pour certaines variables de consommation chez les adolescents présentant davantage de symptômes externalisés. Dans la seconde étude, aucun résultat significatif n’a pu être obtenu quant aux variables de consommations ou de problèmes de santé mentale. Les adolescents ayant reçu l’intervention ont davantage répondu au suivi à 6 mois comparativement à ceux n’ayant pas reçu l’intervention (p =0,003). Conclusion : La première étude est prometteuse quant à l’applicabilité de l’intervention chez des jeunes présentant des symptômes de problèmes psychiatriques. En ce sens, l’absence de résultat significatif pour la seconde étude pourrait possiblement être en partie due à une attrition à 6 mois plus substantielle que celle attendue et donc aux limites statistiques encourues. Cependant, il est aussi possible que l’intervention telle qu’elle a été offerte n’était pas suffisamment approfondie ou n’adressait pas suffisamment d’enjeux propres à cette population clinique. Il a néanmoins pu être observé que l’évaluation et l’organisation des soins des patients n’incluaient pas d’emblée la prise en charge de leur consommation ou problèmes associés. La coordination entre clinique et recherche devrait être optimisée, autant pour supporter la mission que se sont donnée les gouvernements d’harmoniser ces deux dimensions, que pour suivre leurs recommandations quant à la nécessité de prioriser une intégrité des soins chez les patients souffrant de troubles concomitants. / Background: In adolescents, mental health disorders frequently co-occurs with substance misuse, a dual diagnosis that tends to complicate the patient’s treatment and prognosis, resulting in astounding costs for society. Thus, it is critical to investigate how to prevent and reduce substance use problems in this population and optimize their global treatment. According to recent literature and to health provincial and federal governments’ priorities, an integrated services approach has been identified as the strategy to favour. In three randomised-controlled trials, brief personality-targeted interventions have shown to be effective in preventing adolescent onset and growth of drinking, binge-drinking and drinking problems. The personality profiles targeted (Hopelessness/Negative thinking, Impulsivity, Anxiety-Sensitivity, Sensation Seeking) play an important role in the onset and development of both substance misuse and psychiatric symptoms. In this thesis, we hypothesized that brief personality-targeted interventions aiming to prevent and reduce substance misuse in a high-risk population would also benefit a psychiatric clinical sample of adolescents. Methods: To test this hypothesis, 2 studies were conducted as part of this thesis. In the first one, data from an existing sample of adolescents from a school cohort were analysed to determine if among these students, those at high risk of alcohol misuse and presenting with psychiatric symptoms could benefit from this brief intervention. The same intervention was then delivered to a clinical sample of adolescents; this second study was conducted in a psychiatric department in a hospital setting. Results: The first study showed that the intervention was as effective regardless of whether the adolescents reported depression and anxiety symptoms; these symptoms did not moderate the intervention effects on substance misuse and associated problems. However, reporting hyperactivity/impulsivity symptoms and conduct problems did significantly moderate the intervention effects on some drinking outcomes, showing mainly more beneficial intervention effects in adolescents reporting higher levels of externalizing symptoms. In the second study, no significant intervention effects were found regarding substance use and psychiatric symptoms outcomes. Adolescents who received the intervention significantly had higher rates of follow-up compared to those who did not receive the intervention (p =0,003). Conclusion: The first study is promising regarding the applicability of the intervention with adolescents with psychiatric disorders’ symptoms. In that sense, the lack of significant findings in the second study could potentially be explained by attrition and small sample size at follow-up and therefore to the statistical limits encountered. It is also possible that the intervention as delivered did not address the issues specific to this clinical population in enough depth. Nevertheless, it was observed that the evaluation and organization of patient care did not simultaneously include support for patients’ substance use or associated problems. The coordination between treatment and research should be optimized, not only to support the stated mission of governments to harmonize these two dimensions, but also to follow their recommendations as to the need to prioritize the integration of care for patients with comorbid disorders.