1
Problem-solving Consultation with Parents, Teachers and Consultants for Children with
Developmental Delays and Behaviour Problems
Anastasia Karagiannakis, M.Ed.
Ingrid Sladeczek, PhD
Ashleigh Yule, B.A.
Nancy Miodrag, M.A.
McGill University
Faculty of Education
Department of Educational & Counselling Psychology
3700 McTavish Street
Montreal, Quebec, Canada
H3A 1Y2
Tel (001) (514) 398-3450
Fax (001) (514) 398-6968
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Abstract
Problem-solving collaborations between parents, teachers, and consultants have been
found to be highly effective in changing problematic behaviours of children (Noell, Duhon,
Gatti, & Connell, 2002), and have emerged as a viable and cost-effective alternative to more
traditional models of providing services (Kratochwill, Elliott, & Carrington-Rotto, 1995). In the
current study, the authors investigated the efficacy of a comprehensive problem-solving
consultation program involving parents, teachers and consultants for children with
developmental delays and behaviour problems in the home and school environments. The
problem-solving process consisted of a rapport building stage, problem identification and
problem analysis, individualized programming for targeted behaviours, and consultant-led parent
and teacher videotape therapy groups using the parenting program Parents and Children Series
(Webster-Stratton, 1989) and the teacher program Teachers and Children Series (WebsterStratton, 1997). Child outcomes were examined with respect to targeted behaviours and socialemotional functioning as reported by parents and teachers. Parent and teacher outcomes were
examined based on pre- and post-intervention changes on several variables, including knowledge
of behavioural principles and handling parenting situations and classroom situations, perceptions
of stress, views of the intervention acceptability and effectiveness, and overall satisfaction with
the program and consultants. School personnel referred 28 young children for internalizing and
externalizing behaviours. We found that parents and teachers benefited from this intervention
and responded positively to the partnership. Parents and teachers reported significant
improvements in the child’s target behaviours and socio-emotional functioning. Implications
regarding the application of this partnership for servicing children with a variety of special needs
are discussed.
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Purpose and Objectives
The purpose of the current study was to examine the effectiveness of a problem-solving
consultation (PSC) intervention involving parents, teachers, and consultants for children with
developmental delays (DD) and significant behaviour problems in the home and school
environments. The objectives were to:
(a) Examine child outcomes with respect to targeted behaviours and social-emotional
functioning as reported by parents and teachers;
(b) Examine teacher outcomes based on pre- and post-intervention changes on the
following teacher variables: (1) Knowledge of behavioural principles and handling
problematic classroom situations; (2) Views of intervention acceptability, effectiveness,
and time to effectiveness; (3) Overall satisfaction with the program and consultants.
(c) Examine parent outcomes based on pre- and post-intervention changes on the
following parent variables: (1) Knowledge of behavioural principles and handling
parenting situations; (2) Perception of stress; (3) Perception of parenting skills; (4)
Satisfaction and efficacy of being a parent; (5) Views of intervention acceptability,
effectiveness, and time to effectiveness; and (6) Overall satisfaction with the program
and consultants.
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Introduction
Children exhibiting significant behavioural problems benefit from effective home and
school interventions to enhance their behavioural conduct (Galloway & Sheridan, 1994; Grobe,
2007; Noell, Duhon, Gatti, & Connell, 2002; Wayland, 2003). Indirect models of service
delivery (e.g., problem-solving consultation, PSC) are primarily used because school
psychologists can provide services to more children who present behavioural difficulties in
schools or homes through a consultee (e.g., parent or teacher) as opposed to direct, traditional
methods of service delivery (Auster, Feeney-Kettler, & Kratochwill, 2006; Bergan &
Kratochwill, 1990; Kratochwill, Elliott, & Carrington-Rotto, 1995).
Increased behaviour problems, inadequate social abilities and adaptive behaviours as well
as higher levels of depressive symptomatology are consistently noted for children with
developmental delays (DD) (e.g., Eisenhower, Baker, & Blacher, 2003; Guralnick, 1999; Kasari
& Bauminger, 1998; Linna et al., 1999). In contrast to typically developing children, children
with DD have more behaviour problems, are less proficient in eliciting and responding to
emotions in others (e.g., Downs & Smith, 2004; Karsari & Bauminger, 1998), show emotion
recognition deficits (e.g., Adams & Markham, 1991; Downs & Smith, 2004), have difficulty
forming friendships (e.g., Guralnick, Neville, Hammond, & Connor, 2007; Parker, Rubin, Price,
& DeRosier, 1995), and demonstrate poor prosocial behaviours (e.g., Downs & Smith, 2004;
Kasari & Bauminger, 1998).
The prevalence of emotional/behavioural disorders in children with DD has been
estimated to be five times that of typically developing children (Borthwick-Duffy, 1994). Longterm studies report that children with DD continue to be at risk for a variety of difficulties as
adults regarding behavioural, emotional, and social problems (e.g., social isolation, depression,
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chronic job failure, community failure) (e.g., Gallimore, Keogh, & Bernheimer, 1999; Kratzer &
Hodgins, 1997). These findings underscore the urgent need for effective interventions to
remediate behaviour problems in children with DD.
Effective interventions include behavioural management strategies via PSC with parents
and teachers. Although a plethora of research exists examining behavioural management
interventions, fewer researchers have examined PSC, which in this study includes conjoint
behavioural consultation (CBC) combined with group videotape therapy (GVT).
Conjoint Behavioral Consultation (CBC)
Recently, one approach of working with parents and teachers simultaneously in an effort
to help children with behavioural difficulties is conjoint behavioural consultation (CBC;
Sheridan, Eagle, & Doll, 2006; Sheridan & Kratochwill, 1992; Sheridan, Kratochwill, & Elliott,
1990). CBC involves an indirect form of service delivery in which the consultant works
collaboratively with the parents and teachers (the consultees) to improve the parents’ and
teachers’ knowledge and skills so that they can deal more effectively with the child’s behavioural
problems and to address future difficulties (Kratochwill, Elliott, & Busse, 1995; Sheridan,
Clarke, Knoche, & Edwards, 2006; Sheridan & Kratochwill, 1992). It is important to provide
parents and teachers with the skills to effectively intervene with children with DD and BP
because of the decrease in resources to provide direct services in the classroom (Hayden &
DePaepe, 1994). Conjoint behavioral consultation and its variations, now referred to as problemsolving consultation, (Kratochwill & Stoiber, 2002) has extensive empirical evidence attesting to
its efficacy. For example, it has been shown as an effective intervention modality for children
who are socially withdrawn (Wayland, 2003; Wayland & Sladeczek, 1999).
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Videotape Therapy (VT)
Videotape therapy (VT) developed by Webster-Stratton (1989, 1997) represents another
effective venue of alleviating behaviour problems of young children in home and school
environments (Finn, 2003; Webster-Stratton, 1996, 1998, 2005). In fact, Webster-Stratton’s
videotape therapies are recognized as one of two intervention approaches that meet the American
Psychological Association’s criteria for well-established interventions for children with conduct
problems (Brestan & Eyberg, 1998).
Procedure
Participants and Selection Procedure
Teachers from a school for children with special needs in suburban Montreal made initial
referrals to researchers. After parental permission was obtained, children were screened for
eligibility via their responses on the Social Skills Rating System (Gresham & Elliott, 1990) and
the Child Behavior Checklist/Teacher Report Form (Achenbach, 1991). Twenty-eight children,
23 boys and 5 girls, with a mean age of 8.3 years participated in the study. Children were most
often referred for externalizing and internalizing behaviours such as non-compliance, aggressive
behaviour, and inappropriate verbalizations.
Design
A multiple baseline design was used over a 3-year period in which target behaviours were
selected for participants in the school and home setting. After a steady rate of responding was
ascertained for the first group, the intervention was applied to the second group.
Participant Screening Measures
Social Skills Rating System: Teacher and Parent Forms (SSRS; Gresham & Elliott, 1990)
Child Behavior Checklist and Teacher Report Forms (CBCL/TRF; Achenbach, 1991)
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Teacher Measures
Teacher Consultation Service Questionnaire (Forehand, & McMahon, 1981)
Knowledge of Behavioral Principles as Applied to Children (KBPAC; O’Dell et al.,
1979)
Behavioral Intervention Rating Scale (BIRS; Elliott & Treuting, 1991)
Parents Measures
Knowledge of Behavioral Principles as Applied to Children, Parenting Questionnaire
(KBPAC; O’Dell et al. 1979)
Parenting Stress Index (PSI; Abidin, 1990).
Parenting Scale (Arnold, O’Leary, Wolff, & Acker, 1993).
Being a Parent (Johnston & Mash, 1989)
Behavioral Intervention Rating Scale (BIRS; Elliott & Treuting, 1991)
Parent Consultation Service Questionnaire (Forehand & McMahon, 1981)
Procedure: CBC
Four general stages were used as part of the problem-solving consultation process: (a)
Problem Identification Interview (PII); (b) Problem Analysis Interview (PAI)
(c) Intervention implementation; and (d) Treatment Evaluation Interview (TEI) (Kratochwill,
Elliott, & Stoiber, 2002). These stages are described linearly but often overlap in practice.
Procedurally they are operationalized through a series of standardized interviews.
The PII was the first behavioural interview that was also used as a step in the screening
procedure. The consultant and consultees specified and defined the problem to be targeted in
consultation.
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After the PII, the second interview, the PAI was held. The consultant and consultees: (a)
Reviewed baseline data; (b) Discussed and identified antecedents precipitating the target
behaviour; (c) Discussed and identified consequent conditions that maintained the problematic
behaviour; (d) Discussed and identified the sequential conditions (e.g., situational events)
contributing to the target behaviour; and (e) Consultant and consultees then developed the
intervention plan.
During intervention implementation, the behavioural intervention was put into practice.
After the intervention, the TEI was conducted to determine the effectiveness of the intervention
and to decide whether to continue, modify, or terminate consultation and to discuss procedures of
maintenance and generalization (Kratochwill et al., 2002; Sheridan, Kratochwill, & Bergen,
1996).
Procedure: Manual
A manual-based approach for delivering the Social Program for Children (Kratochwill &
Elliott, 1991) to parents and teachers was used and included four components:
(a) Skill selection and goal setting - this section of the program was used to help parents
and teachers identify social skills or behaviours targeted for the intervention. Focusing on one
problem at a time, the consultant and the consultees formulated an intervention plan. The goal of
the plan is to help the child develop the selected skill by practicing the following steps: Tell,
Show, Do, and Goal Setting and Practice.
(b) Peer Activity - Provides the child with the opportunity to play with a peer at least
once a week. Eight steps for initiating peer activity are outlined in the manual. These include:
deciding with the consultant on the type of activity, telling the children what behaviours are
9
expected, praising the children when they display prosocial behaviors, and providing the child
with feedback.
(c) Positive Reinforcement - Positive reinforcement was administered on a continuous
schedule and additional “special rewards“ (e.g., extra time for play) were provided for reaching
daily and weekly goals.
(d) Child Management - consists of differential attention, instruction giving, and time out.
Procedure: Group Videotape Therapy (GVT)
In the second component of PSC, parents and teachers viewed and discussed in group
sessions the materials conveyed in the Parents and Children Series and the Teacher and
Children Series, respectively (Webster-Stratton, 1989, 1997), which are comprehensive videobased courses for parents, teachers, and other child caregivers. The Parent and Children Series
consists of four programs: (a) Play; (b) Praise and rewards; (c) Effective limit setting, and (d)
Handling misbehaviour. The Teacher and Children Series is comprised of six programs: (a)
Importance of teacher attention, encouragement, and praise; (b) Motivating children through
incentives; (c) Preventing behaviour problems-The proactive teacher; (d) Decreasing students’
inappropriate behaviours; (e) Building positive relationships with students; and (f) How to teach
social skills, problem-solving, and anger management in the classroom. Essential child-rearing
concepts and classroom behaviour management strategies were illustrated with brief vignettes of
parents or teachers interacting with children in common home or classroom situations. After each
vignette, participants, led by the consultant, discussed important points and practiced new skills
in role-playing exercises and homework assignments. The group leader was responsible for
making assignments, organizing the material and videotapes, conducting discussions, and
10
reviewing homework. Individual intervention plans were designed based on a functional analysis
of the targeted behaviour.
Intervention: Conjoint Behavioural Consultation (CBC)
In problem analysis, the baseline data were analyzed by identifying variables that may
assist in finding a solution. Based on this analysis, a plan was designed to solve the target
problem. During the intervention implementation stage, the behavioural intervention was put into
practice. Lastly, the intervention evaluation stage was undertaken to determine the effectiveness
of the plan and discuss procedures of maintenance and generalization (Kratochwill et al., 2002;
Sheridan, Kratochwill, & Bergan, 1996).
Intervention: Group Videotape Therapy (GVT)
The Parent and Children’s Series (Webster-Stratton, 1989) and Teacher and Children’s
Series (Webster-Stratton, 1997) were used. Videotape therapy (VT) is a multicultural
intervention program that instructs parents and teachers on the appropriate use of a number of
behavioural management strategies (e.g., how to set limits, how to decrease inappropriate
behaviours). The therapy can be conducted in groups led by a therapist or in a self-administered
format. We have chosen GVT, since the intervention outcome data are stronger (i.e., significant
reductions in the children's problematic behaviours and increases in prosocial behaviours) (e.g.,
Webster-Stratton, 1989, 1990, 1997, 2005).
Data Analysis: Target Behaviours
Means (M) and standard deviations (SD) were calculated for each target behaviour in the
home and school settings. Effect Sizes (ES) for target behaviours were calculated to determine
whether the combined GVT and CBC intervention had improved the target behaviours from preand post-intervention for individual children. Reliability Change Indices (RCI) examine the
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changes from pre- to post-intervention based on standardized measures. RCIs were computed to
evaluate whether parents’ and teachers’ perceptions of the children’s socio-emotional and
behavioural functioning, understanding of behavioural principles, and their parenting style
changed significantly post-intervention.
Results: School Setting
Overall ES: Target Behaviours at School
% in the
Minimum
Maximum
M
SD
expected
direction
Home
-6.33
.73
-1.83
1.78
100
School
-2.64
7.76
-1.15
2.21
81
Overall
Mean ES
-1.49
12
RCI: Teacher
Minimum
Maximum
M
SD
TRF TOT
-3.47
3.75
-.47
1.92
TRF EXT
-4.27
3.20
.23
2.05
TRF INT
-1.71
3.20
-6.34
1.32
SSRS SS
.00
5.09
1.00
1.28
SSRS PB
-.64
7.81
.63
1.99
KBPAC
-.63
-1.88
.74
.92
BIRS
Teachers indicated that they found the intervention to be acceptable, effective, and time
to effectiveness (i.e., the amount of time that the teachers took to view the intervention to be
acceptable) was viewed positively. However, teachers’ perceptions did not change significantly
from pre- to post-intervention.
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Teacher Consultation Services Questionnaire (TCSQ /100)
TCSQ
Minimum
Maximum
M
SD
Overall Program
60
90
78.77
9.62
Teaching Format
57.14
92.86
69.94
12.76
Teacher Benefits
64.29
100
79.92
12.22
Perception of
57.14
100
79.91
13.91
Consultants
Results: Home setting
Overall ES: Target Behaviours at Home
% in the
Minimum
Maximum
M
SD
expected
direction
Home
-6.33
.73
-1.83
1.78
100
School
-2.64
7.76
-1.15
2.21
81
Overall
Mean ES
-1.49
14
Effect Size: -5.06
Target Behaviour: # of reminders following initial reminder within a 5-minute period to remove
fingers from mouth
Frequency
Home Observations for Child
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
Effect Size: -1.78
Observations
Target Behaviour: Non-compliance to parental requests
Home Observations for Child
5
Frequency
4
3
2
1
0
Observations
15
RCI: Parent
Minimum
Maximum
M
SD
CBCL TOT
-3.21
2.94
-.52
1.59
CBCL EXT
-5.07
1.60
-.68
1.44
CBCL INT
-3.20
2.56
-.23
1.39
SSRS SS
-.39
4.18
1.22
1.17
SSRS PB
-1.49
6.94
.43
1.73
KBPAC
-1.75
5.01
2.32
1.85
BIRS
Parents rated the intervention as acceptable but perceptions of acceptability did not
change significantly as a function of participation. Although acceptable, parents viewed the
intervention as less effective after participation in the program in terms of their perceptions of
comparisons to other children who are typically developing. Time to effectiveness was rated very
highly by parents although it did not significantly change from pre- to post-intervention
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Parent Consultation Service Questionnaire (PCSQ /100)
PCSQ
Minimum
Maximum
M
SD
Overall Program
58.44
92.21
78.22
9.66
Parent Benefits
51.02
95.92
79.19
13.05
Perceptions of
62.24
98.98
81.74
11.34
Consultants
RCI: Parenting Scale
Minimum
Maximum
M
SD
Laxness
-3.43
2.40
-.17
1.68
Overreactivity
-3.97
3.97
.00
2.59
Verbosity
-1.89
2.46
-.29
1.50
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Being A Parent
Although not statistically significant, positive effects on parents’ perceptions of the
following were maintained: (a) satisfaction with their parenting skills (e.g., frustration, feeling
manipulated, and tension); and (b) effectiveness with parenting skills (manageable, meeting
expectations, have the skills, and familiar with their parenting role)
Parenting Stress Index
PSI
Minimum
Maximum
M
Pre
Post
Pre
Post
Pre
Post
24
13
49
39
33.14
26.67 7.46
8.21
18
16
50
39
30.43
25.92 8.69
6.99
Difficult Child 29
28
51
50
40.64
35.5
7.02
7.38
Defensive
14
8
29
26
20.43
16.75 4.13
5.56
78
64
150
117
104.21 87.33 18.82 18.07
Parental
SD
Pre
Post
Distress
Parent-Child
Dysfunctional
Interaction
Responding
Total
Significant findings were found for Difficult Child, t (1,9) = 3.27, p = 0.010,
and Total, t (1, 9) = 3.24, p = 0.010
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Discussion
Overall, teachers and parents benefited from this unique intervention that combined
problem-solving consultation with consultant-led videotape therapy. More specifically, teachers
and parents reported more prosocial behaviours (e.g., appropriate play with sibling) as evidenced
by significant decreases in the children’s externalizing or internalizing behaviours from pre- to
post-intervention. Children significantly improved their social skills, problem behaviours, and
overall socio-emotional functioning as reported by teachers and parents.
As a result of participating in a problem-solving partnership, teachers’ and parents’
knowledge in dealing with problem behaviours significantly improved. (e.g., how to give praise
or when to give consequences). Intervention treatment acceptability as reported by parents and
teachers was high and positively correlated with intervention outcomes (e.g., correlated with
enhanced social skills). Following implementation of the CBC + GVT intervention, parents and
teachers reported greater overall satisfaction with the program, found it to be beneficial, and
perceived the consultants competence throughout the program to be valuable.
Overall, total parents’ stress levels decreased significantly as a function of the child
participating in the intervention. Specifically, as children’s behaviours improved (e.g., less
crying, decreased interruptions, minimal fighting and whining), parents perceived their child to
be less difficult and therefore their stress levels were significantly reduced. As a result of
participating in the program, findings provide evidence to suggest that parents demonstrated
greater calmness, conciseness, and were more attentive and firm in the delivery of verbal
commands.
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Implications of this Study
 If parenting skills improve, then teacher-child relationships can improve;
 Better behaviours of the child can lead to improved social interactions with peers,
siblings, and enhanced academic performance;
 Educational and school psychologists could see the possibility of providing
intervention services to a greater diversity of parents, teachers, and children with a
variety of special needs;
 The number of children experiencing various behavioural difficulties exceeds
personnel and resources available; therefore, the need for cost-effective and time
effective interventions for these children is critical;
 When used in a group format, GVT and CBC are cost-effective as well as
efficient (Webster-Stratton, 1989, 1997);
 Early intervention in the critical developmental periods is necessary to prevent
secondary interventions later in life (e.g., remediation, special services in the
schools).
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