Elsevier

Journal of School Psychology

Volume 97, April 2023, Pages 171-191
Journal of School Psychology

Universal Teacher-Child Interaction Training in early childhood special education: A cluster randomized control trial

https://doi.org/10.1016/j.jsp.2023.02.001Get rights and content

Abstract

Growing evidence suggests that Teacher-Child Interaction Training-Universal (TCIT-U) is effective for increasing teachers' use of strategies that promote positive child behavior, but more rigorous research with larger, diverse samples is needed to understand the effects of TCIT-U on teacher and child outcomes in early childhood special education. Using a cluster randomized control trial, we evaluated the effects of TCIT-U on (a) teacher skill acquisition and self-efficacy and (b) child behavior and developmental functioning. Teachers in the TCIT-U group (n = 37) exhibited significantly greater increases in positive attention skills, increased consistent responding, and decreased critical statements relative to teachers in the waitlist control group (n = 36) at post and 1-month follow-up (d's range from 0.52 to 1.61). Teachers in the TCIT-U group also exhibited significantly fewer directive statements (d's range from 0.52 to 0.79) and greater increases in self-efficacy compared to waitlist teachers at post (d's range from 0.60 to 0.76). TCIT-U was also associated with short-term benefits for child behavior. Frequency (d = 0.41) and total number of behavior problems (d = 0.36) were significantly lower in the TCIT-U group than in the waitlist group at post (but not follow-up), with small-to-medium effects. The waitlist group, but not the TCIT-U group, demonstrated an increasing trend in number of problem behaviors over time. There were no significant between-group differences in developmental functioning. Current findings build support for the effectiveness of TCIT-U as universal prevention of behavior problems with an ethnically and racially diverse sample of teachers and children, including children with developmental disabilities. Implications for implementation of TCIT-U in the early childhood special education setting are discussed.

Introduction

Decades of developmental research have underscored the importance of early social-emotional development for enhancing children's short-term and long-term trajectories (Guerra & Bradshaw, 2008). Deficits in social-emotional skills can be associated with the emergence of externalizing behavior problems (e.g., aggression, non-compliance, hyperactive and impulsive behaviors). Externalizing behavior problems are a common concern in early childhood education settings as they can interfere with learning, challenge the classroom environment, and lead to a broad range of adverse outcomes, including reduced school readiness and increased use of expulsion (Gilliam, 2005; Webster-Stratton et al., 2008). Children with disabilities, who exhibit higher rates of externalizing behavior problems than their typically developing peers (Emerson & Einfeld, 2010; Fauth et al., 2017), are more likely to experience exclusionary discipline practices, including expulsion and suspension, in K–12 settings (Sullivan et al., 2014). Recent data suggest that these higher rates of expulsion for children with disabilities may begin in preschools where overall expulsion rates are already as much as three times higher than in K–12 settings (Gilliam, 2005; Zeng et al., 2021). Use of exclusionary discipline strategies, particularly for children with disabilities, has significant implications for depriving these children of crucial educational and therapeutic services (Zeng et al., 2021). Importantly, it is well documented that suspension and expulsion rates are also consistently higher among Black/African American and Hispanic/Latinx children than among their White, non-Hispanic/Latinx peers (Gopalan & Nelson, 2019). Furthermore, there is a growing body of research suggesting that teachers' expectations (e.g., anticipating problem behaviors) and behaviors (e.g., frequency of positive speech directed to students) with children may differ based on child race, favoring White, Non-Hispanic/Latinx children (Gilliam et al., 2016; Tenenbaum & Ruck, 2007). As we continue to strive to address inequities in the quality of teacher-child interactions and in the use of exclusionary practices for managing behavioral challenges in the classroom, it is important to understand how to best equip teachers to meet the behavioral needs of all children in early childhood education settings, including children at the intersection of minoritized groups, defined as social identity groups (e.g., race, ethnicity, disability) that have been historically marginalized and/or underrepresented (Vacarro & Newman, 2016).

For young children with disabilities, early childhood special education programs are a primary setting for intervention due to the accessibility for students, the naturalistic environment which supports learning and generalization, and the dosage that can be delivered during each school day (Cowan & Allen, 2007). Despite these benefits, research suggests that special education does not consistently address children's behavior problems (Morgan et al., 2010). This is not surprising given evidence that early childhood education centers' discipline policies are vague and often do not outline specific evidence-based practices for managing challenging behaviors (Garrity et al., 2017). Moreover, educational qualifications for teachers and assistants in early childhood education can vary greatly. Although teachers in public school special education programs are often required to have a bachelor's or master's degree in education or a related field, this is not necessarily the case in other early childhood education settings, including early childhood special education and early intervention programs not integrated within the public school system (Manning et al., 2017). Furthermore, early childhood special education teachers vary in the quantity and quality of pre-service and in-service behavior management training they receive and often report feeling underprepared to manage the wide range of behavioral needs of their students (Oliver & Reschly, 2010; Schonert-Reichl et al., 2015). Lack of proper training and support may result in the use of ineffective behavior-management strategies, such as punitive discipline and inconsistent responding to desirable and undesirable behaviors, which can maintain or worsen challenging behaviors, increase teacher stress, and perpetuate the use of harmful exclusionary practices among children who are already at increased risk. Consequently, identifying and disseminating effective training models that equip early childhood special education teachers and programs to effectively meet the behavioral needs of their students is an important area of focus in early childhood research.

In recent years, there has been increased emphasis on extending multi-tiered systems of support (MTSS) models, which have been widely used in the elementary and middle school settings for several decades, to early childhood education settings (National Association for the Education of Young Children, National Head Start Association, and Division for Early Childhood of the Council for Exceptional Children, 2014). Multi-tiered models, such as Program-Wide Positive Behavior Supports (PW-PBS; also known as the Pyramid Model; Hemmeter et al., 2016), consist of a continuum of evidence-based universal prevention (Tier 1), secondary prevention (Tier 2), and targeted intervention (Tier 3) supports to promote social-emotional competence and school readiness in all children, including those who are at risk for developing more serious problem behavior (Walker & Shinn, 2010). Within the MTSS framework, Tier 1 supports are applied at the classroom level to promote nurturing, responsive caregiver-child relationships within the context of high-quality supportive environments. Whereas curriculum-based Tier 1 social-emotional learning programs are designed to explicitly teach children social-emotional competencies (e.g., self-awareness, self-management) and may require implementation by specialists to maximize outcomes (Blewitt et al., 2018), relationship-focused interventions emphasize enhancing teacher-child interactions as the mechanism for child social-emotional learning and behavioral success (Mashburn et al., 2008; Pianta et al., 1997). Relationship-focused interventions may be particularly useful for reducing the frequency and impact of challenging behaviors within early childhood special education classrooms by equipping teachers with a core set of interaction skills that can be tailored to the diverse developmental and behavioral needs of children with and without disabilities. However, little is known about the use of Tier 1 relationship-focused interventions within the context of early childhood special education settings where characteristics of the children served (e.g., language level, cognitive functioning) and of the setting itself (e.g., emphasis on individualized Tier 3 interventions) may require special considerations for implementation and for measuring and understanding outcomes.

Teacher Child Interaction Training (TCIT) is a coaching intervention that specifically targets teacher communication and interaction skills as the mechanisms for supporting positive teacher-child relationships and positive behavior in children with diverse developmental and behavioral needs (Budd et al., 2016; Budd & Stern, 2017). TCIT was developed as a school-based adaptation of Parent-Child Interaction Therapy (PCIT), a parent-mediated intervention with a large body of research supporting its effectiveness in reducing disruptive behavior (e.g., Thomas et al., 2017), enhancing the caregiver-child relationship (Bagner et al., 2016), and improving child communication skills (Garcia et al., 2015) in children with disruptive behaviors, including those with developmental disabilities (Bagner & Eyberg, 2007; Parladé et al., 2020). Like PCIT, TCIT is rooted in attachment, social learning, and behavioral theories, play therapy principles, and research on effective parenting styles (Budd & Stern, 2017), and it emphasizes the use of proactive strategies and consistency in responding to children's behaviors. Most variations of TCIT (for a review, see Fernandez, Gold, et al., 2015) follow a two-phase structure and include workshops, guided practice, and in-vivo coaching in the naturalistic setting as the primary training modalities. Child-Directed Interaction (CDI) skills are taught first to increase positive teacher-child interactions and teacher attention to positive behavior. Teacher-Directed Interaction (TDI) skills are taught in a second phase to increase compliance and on-task behavior and reduce disruptive behaviors through consistent teacher responding and differential social attention.

There is growing support for TCIT as an effective primary and secondary prevention approach associated with positive changes in student and teacher functioning. In teachers, TCIT has been related to increased positive verbalizations (Fawley et al., 2020; Fernandez, Adelstein, et al., 2015; Lyon et al., 2009; Tiano & McNeil, 2006) and reduced critical statements toward their students (Fernandez, Adelstein, et al., 2015; Kanine et al., 2018). Results related to directive teacher verbalizations are more variable across studies, as some studies show a decrease in the frequency of questions and commands (Kanine et al., 2018), whereas other studies show these remaining stable following intervention (Fernandez, Adelstein, et al., 2015). Teachers have also reported strong satisfaction with TCIT (Budd et al., 2016; Fawley et al., 2020; Lyon et al., 2009) and reduced stress related to managing challenging behavior (Fernandez, Adelstein, et al., 2015). In students, TCIT has been associated with increased prosocial behavior (Budd et al., 2016; Campbell, 2011; Davidson et al., 2021; Fawley et al., 2020; Garbacz et al., 2014; Kanine et al., 2018) and decreased disruptive behaviors, with effect sizes ranging from 0.17 to 0.90 (Budd et al., 2016; Campbell, 2011; Davidson et al., 2021; Fernandez, Adelstein, et al., 2015).

To date, TCIT has been examined in various educational settings (e.g., Head Start, public school primary grades, therapeutic preschool for maltreated children), and there is initial support for TCIT with children with disabilities within mainstreamed special education (Budd et al., 2016) and self-contained special education classrooms (Davidson et al., 2021; Kanine et al., 2018), yet larger, controlled studies are needed to better understand how TCIT impacts teacher and child outcomes in early childhood special education, particularly with racially and ethnically diverse samples, to ensure widespread acceptability and scalability. Many TCIT studies have included primarily White children (Budd et al., 2016; Tiano & McNeil, 2006), whereas several studies have included primarily Black/African American children (Garbacz et al., 2014; Kanine et al., 2018; Lyon et al., 2009), and only one study included a large number of Hispanic/Latinx children (Fernandez, Adelstein, et al., 2015). Moreover, except for two studies with predominantly Black/African American teachers (Garbacz et al., 2014; Kanine et al., 2018), the majority of teachers have been White, non-Hispanic/Latinx females trained in English (Budd et al., 2016; Fawley et al., 2020; Fernandez, Adelstein, et al., 2015; Lyon et al., 2009. Fawley et al. (2020) reported that 75% of students in the school were English Language Learners, yet, to our knowledge, our team's pilot study (Davidson et al., 2021) was the first to report outcomes on TCIT that includes training and coaching teachers in Spanish in response to the language needs of the teaching staff. Given the emphasis of TCIT on changing teacher behaviors, including teacher language, training in TCIT must be sensitive to the language needs of the teachers and children who are delivering and receiving the intervention. Furthermore, despite emerging support for the effectiveness and acceptability of TCIT with different teacher and student populations and across settings, little attention has been given to how specific TCIT components can be tailored to best meet the needs of racially, ethnically, linguistically, and developmentally diverse populations. Understanding these factors is essential for establishing TCIT as a sustainable, scalable, and culturally responsive universal prevention intervention embedded within early childhood special education programs.

As part of a larger initiative focused on expanding the research and reach of promising early childhood practices with high-need populations, our team received funding in partnership with birth-to-two special education programs in low-income communities serving racially and ethnically minoritized children to examine the impact of a specific variation of TCIT, Teacher Child Interaction Training-Universal (TCIT-U; Budd & Stern, 2017), on the quality of teacher-child interactions and on the behavioral and developmental functioning of young children, including those with developmental disabilities. Notably, there are different TCIT protocols that have been created by different research teams (Fernandez, Adelstein, et al., 2015; Fernandez, Gold, et al., 2015). TCIT-U was selected as the specific TCIT model due to its emphasis on universal prevention for all children with a broad range of behavioral and developmental needs. For the initial study phase (see Davidson et al., 2021), focus groups were conducted before TCIT-U implementation to better understand the needs of the children and to understand how teachers and caregivers perceived TCIT-U. Training materials were translated to Spanish to support linguistically sensitive training and coaching for teaching staff, many of whom identified Spanish as their primary learning language. Importantly, bilingual Spanish/English trainers conducted the training and coaching, which allowed for trainers to adjust their training approach to the linguistic needs of each teacher (i.e., English only, Spanish only, or mixed English and Spanish). A pilot matched-pairs cluster-randomized control trial (RCT) was used to evaluate TCIT-U with a diverse sample of 36 teachers and 144 students (80% with an established developmental disability) across 12 classrooms in three participating birth-to-two early childhood special education programs.

Results of the pilot showed increased teacher use of CDI skills and small, significant improvements in student behavior and social-emotional functioning in the TCIT-U group relative to the waitlist group, yet there were no significant group differences in the reduction of directive teacher statements or rates of consistent responding. Furthermore, teachers reported high levels of satisfaction with the CDI skills, yet there was concern regarding the appropriateness of certain TDI strategies (e.g., Sit-and-Watch procedure for aggressive behaviors; selective ignoring) for the population of young children, many of whom had various forms of delays and disabilities (e.g., autism, deaf/hard of hearing, speech delay, global delay). We described the need for further tailoring of content (e.g., examples adjusted to reflect the activities and language of children with low receptive and expressive language skills) and of coaching (e.g., increased emphasis on scaffolding the level of support provided to children during teacher-directed interactions) within TCIT-U for students with disabilities in rolling out a larger-scale RCT (see Table 1 for tailoring examples). Our team also capitalized on the flexibility inherent in TCIT-U to ensure training and implementation were conducted in ways that were sensitive to the unique culture of each school and the individual preferences and styles of each teacher. For instance, for teachers with a more directive interaction style that may stem from firmly held cultural beliefs and values, coaching often focused less on reducing the frequency of directive statements and more on helping teachers to provide wait time after commands and questions and to reinforce child effort and compliance with positive attention. Furthermore, results of the pilot study and focus group feedback indicated a need for teachers to receive additional coaching beyond the initial 12 sessions to support increased proficiency.

The present study was designed to extend the pilot trial discussed above (Davidson et al., 2021) by implementing the rigorous RCT design with a larger, diverse sample of teachers and students to better understand how TCIT-U, when tailored to young children within early childhood special education, impacted teacher and child outcomes. Specifically, the evaluation of the effectiveness of TCIT-U was centered around three primary aims. First, we aimed to explore whether teachers significantly increased their use of TCIT-U skills with this population, which is conceptualized as a proxy for dosage of the intervention to students. We hypothesized that following training in TCIT, teachers in early childhood special education would significantly increase their use of CDI and TDI skills as measured and defined by the Teacher-Child Interaction Coding System (TCICS; Budd & Stern, 2017). Second, we assessed whether TCIT-U, tailored and refined based on results of the initial pilot trial, supported social-emotional functioning and reduced the frequency of problematic child behaviors in a racially and ethnically diverse sample of children, many of whom had developmental disabilities. We hypothesized that children in TCIT-U classrooms would show a greater decrease in teacher-reported challenging behaviors and higher increase in teacher-reported prosocial behaviors than children whose teachers did not receive TCIT-U. Third, we set out to evaluate whether TCIT-U would help teachers feel more equipped to manage the behavioral needs of young children with disabilities, with the expectation that teachers who participated in TCIT-U would show greater confidence in their behavior management skills than teachers not receiving TCIT-U.

Section snippets

Participants

The current study included 26 classrooms among eight schools (total of 260 students) as an extension of the previous pilot RCT of TCIT-U (see Davidson et al., 2021). The eight participating schools (across five agencies/institutions) were selected due to their collaboration with the state's early intervention system and the local school district to provide early intervention to children ages birth to 2 years who qualified for services under the Individuals with Disabilities Education Act (

Results

Descriptive statistics for all study variables can be found in Table 5 (for teacher data) and Table 6 (for student data).

Discussion

The present study extended our initial pilot trial (Davidson et al., 2021) by conducting a large-scale RCT of TCIT-U with a racially and ethnically diverse sample of young children, many of whom were at the intersection of minoritized racial, ethnic, and disability groups. Our findings substantiate the small but growing literature base on TCIT-U by demonstrating the positive impacts of TCIT-U on teacher-child interactions, child externalizing behavior, and teacher self-efficacy. Although many

Declaration of Competing Interest

Authors E.D. and B.D. receive fees for providing training and consultation in TCIT-U.

Acknowledgements

This research was generously supported by a grant from The Children's Trust (grant no. ECR XX36-7570). The funder had no involvement in study design, collection, analysis or interpretation of data, writing of the report, or decision to submit the article for publication. The time and effort for M.L.B. to prepare this manuscript was supported by the National Institute of Mental Health (K01MH110608). The authors would like to acknowledge teachers and staff who participated in this study, research

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