Implementation Strategy Resource Package for Behavioral Classroom Interventions: Pilot Test

Promoting Implementation of Behavioral Classroom Interventions for Children With ADHD in Urban Schools: A Pilot Test, Aim 3

The purpose of this study is to pilot test for feasibility and initial promise an implementation strategy resource package that aims to support teachers in using behavioral classroom management interventions for children with hyperactive, inattentive, or impulsive behaviors. Participating teachers will be randomized to receive the resource package or support as usual and the research team will examine, a) teacher implementation of behavioral classroom interventions and b) mental health outcomes for enrolled children.

Study Overview

• Status: Completed
• Conditions: Attention Deficit Hyperactivity Disorder Symptoms
• Intervention / Treatment: Behavioral: Positive Behavior Management Toolkit

Detailed Description

Schools are an accessible and ecologically valid setting for children with hyperactivity, inattentive, or impulsive behaviors to receive evidence-based interventions to reduce symptoms and improve functioning. Behavioral classroom management interventions are well-established treatments for elementary-school age children with, but they can often be challenging for teachers to use. It is therefore important to develop and test implementation strategies in promoting teachers' use of behavioral classroom management interventions and in improving child outcomes. The purpose of this study is to pilot test for feasibility and initial promise an implementation strategy resource package that aims to support teachers in using behavioral classroom management interventions for children with hyperactive, inattentive, or impulsive behaviors. Participating teachers will be randomized to receive the resource package or support as usual and the research team will examine, a) teacher implementation of behavioral classroom interventions and b) mental health outcomes for enrolled children.

• Study Type: Interventional
• Enrollment (Actual): 53
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19146
      • Children's Hospital of Philadelphia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 4 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

Teachers:

• A K-5 teacher at a participating school within the School District of Philadelphia
• Teach at a participating school
• Informed consent

Children:

• Is in a K-5 class of a participating teacher
• Nominated for participation by the participating teacher
• Identified by their participating teacher as displaying impairment related to inattention, hyperactivity or impulsivity
• Informed consent and assent if appropriate

Parents/Legal Guardians:

• Parent or legal guardian of child
• Identifies as familiar enough with the child to fill out measures about the child
• Has mental capacity to provide consent for the participation of child in the study and for their own participation in the study

Caregivers:

• Has been referred by the legal guardian as the primary caregiver that can more accurately complete the measures about the child
• Has mental capacity to provide consent for the participation of child in the study and for their own participation in the study

Exclusion Criteria:

Children:

• Special education classification of 'intellectual disability'
• Primary presenting concern of psychotic or autism spectrum disorders
• Presents as in acute risk of harm to self or others, such that participation in the study is clinically inappropriate because they warrant more intensive intervention

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Implementation Resource Package Group; Teachers in this group will receive an implementation support package and receive support in using it within their classroom management practice. Also within the intervention group (experimental), will be students nested in the classrooms of the teachers that are assigned to the intervention group.	Behavioral: Positive Behavior Management Toolkit; The Positive Behavior Management Toolkit, or the implementation strategy resource package, is a set of resources provided to teachers in the intervention group that aims to support their use of positive behavior management practices in the classroom, particularly with students with hyperactive, inattentive, or impulsive behaviors.; Other Names: Implementation Strategy Resource Package; Support School Success - Teacher Version (SSS-T)
No Intervention: Control Group; Within the control group (no intervention), teachers in this group will not receive the implementation support package nor extra support during the study period. They will continue to receive implementation support as usual. Also within the control group (no intervention) will be students nested in the classrooms of the teachers that are assigned to the control group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility of Intervention Measure	Teacher-reported total score on the Feasibility of Intervention Measure (FIM), which consists of 4 items on a 5-point Likert scale (from 1 = Completely Disagree to 5 = Completely Agree). The total score is the average of the 4 item scores (possible range: 1 through 5, where 5 is the best possible outcome).	Endpoint (i.e, at least 8 weeks from resource package receipt)
Acceptability of Intervention Measure (AIM)	Teacher-reported total score on the Acceptability of Intervention Measure (AIM), which consists of 4 items on a 5-point Likert scale (from 1 = Completely Disagree to 5 = Completely Agree). The total score is the average of the 4 item scores (possible range: 1 through 5, where 5 is the best possible outcome).	Endpoint (i.e, at least 8 weeks from resource package receipt)
Intervention Appropriateness Measure (IAM)	Teacher-reported total score on the Intervention Appropriateness Measure (IAM), which consists of 4 items on a 5-point Likert scale (from 1 = Completely Disagree to 5 = Completely Agree). The total score is the average of the 4 item scores (possible range: 1 through 5, where 5 is the best possible outcome).	Endpoint (i.e, at least 8 weeks from resource package receipt)
Change in Observed Teacher Use of Behavioral Classroom Management Interventions	A member of the study will conduct classroom observations to measure fidelity of teacher use of the behavioral classroom management interventions.	Baseline, midpoint (i.e., up to 7 weeks from resource package receipt), endpoint (i.e, at least 8 weeks from resource package receipt)
Change in Caregiver-reported Child Functional Impairment	Caregiver-reported performance items on the National Institute for Children's Health Quality Vanderbilt Scale - Parent Version; These 7 items are rated on a 5-point scale (from 1 = Excellent to 5 = Problematic). The total score is the average of the 7 item scores (possible range: 1 through 5, where 1 is the best possible outcome).	Baseline, endpoint (i.e, at least 8 weeks from resource package receipt)
Change in Teacher-reported Child Functional Impairment	Teacher-reported performance items on the National Institute for Children's Health Quality Vanderbilt Scale - Teacher Version; These 8 items are rated on a 5-point scale (from 1 = Excellent to 5 = Problematic). The total score is the average of the 8 item scores (possible range: 1 through 5, where 5 is the best possible outcome).	Baseline, endpoint (i.e, at least 8 weeks from resource package receipt)
Change in Academic Productivity	Teacher-reported Academic Productivity subscale score of the Academic Performance Rating Scale (APRS). The Academic Productivity subscale includes 12 items, each rated on a 5-point Likert scale from 1 to 5. Four items are reverse scored, and the total score is computed as the average of the 12 items (possible range: 1 through 5, where 5 is the best possible outcome).	Baseline, endpoint (i.e, at least 8 weeks from resource package receipt)
Change in Student-Teacher Relationship	Teacher-reported total score on the Student-Teacher Relationship Scale - Short form, which consists of 15 items, rated on a 5-point scale (from 1 = Definitely does not apply to 5 = Definitely applies). Eight items are reverse score, and then the total score is computed as the average of the 15 item scores (possible range: 1 through 5, where 5 is the best possible outcome).	Baseline, endpoint (i.e, at least 8 weeks from resource package receipt)
Feasibility of Research Procedures - Recruitment Numbers	Number of teachers and students enrolled in the study	Baseline
Feasibility of Research Procedures - Response Rate	Percentage of parent- and teacher- report surveys completed across timepoints and conditions out of the number of students enrolled and randomized.	Baseline, endpoint (i.e, at least 8 weeks from resource package receipt)
Feasibility of Research Procedures - Retention Rate	Percentage of participants who do not withdraw out of the number of enrolled and randomized teachers and students across conditions	Baseline, midpoint (i.e., up to 7 weeks from resource package receipt), endpoint (i.e, at least 8 weeks from resource package receipt)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Homework Performance	Caregiver-reported student self-regulation factor on the Homework Performance Questionnaire - Parent Version for students in grades 1-5. The self-regulation factor consists of 9 items, each rated on a 4-point scale (0 = rarely/never, 1 = some of the time, 2 = most of the time, 3 = always/almost always). Four items are reverse scored, and then the self-regulation factor score is computed as the average of the 9 item scores (possible range: 0 through 3, where 3 is the best possible outcome).	Baseline, endpoint (i.e, at least 8 weeks from resource package receipt)
Change in Caregiver-reported ADHD Symptoms	Caregiver-reported inattention and hyperactivity/impulsivity symptom scores on the National Institute for Children's Health Quality Vanderbilt Scale - Parent Version, which consists of 18 items, rated on a 4-point scale (from 0 = Never to 3 = Very Often). The total score is calculated as the average of the 18 item scores (possible range: 0 through 3, where 0 is the best possible outcome).	Baseline, endpoint (i.e, at least 8 weeks from resource package receipt)
Change in Teacher-reported ADHD Symptoms	Teacher-reported inattention and hyperactivity/impulsivity symptom scores on the National Institute for Children's Health Quality Vanderbilt Scale - Teacher Version, which consists of 18 items, rated on a 4-point scale (from 0 = Never to 3 = Very Often). The total score is calculated as the average of the 18 item scores (possible range: 0 through 3, where 0 is the best possible outcome).	Baseline, endpoint (i.e, at least 8 weeks from resource package receipt)
Change in Academic Success	Teacher-reported Academic Success subscale score of the Academic Performance rating Scale (APRS). The Academic Success subscale includes 7 items, each rated on a 5-point Likert scale from 1 to 5. One item is reverse scored, and the total score is computed as the average of the 7 items (possible range: 1 through 5, where 5 is the best possible outcome).	Baseline, endpoint (i.e, at least 8 weeks from resource package receipt)
Change in Disruptive Direct Behavior Ratings	Teacher-reported ratings on the disruptive behavior domain of Direct Behavior Rating Multi-Item Scales, which consist of 5 items on a 6-point scale (from 0 = "not a problem" to 6 = "serious problem"). The total score is computed as the average of the 5 items (possible range: 0 through 6, where 0 is the best possible outcome).	Baseline, endpoint (i.e, at least 8 weeks from resource package receipt)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Potential Mediators of Teacher Implementation Outcomes	Teacher self-reported measures of habits regarding their use of behavior-specific praise. This consists of 12 items on a 5-point Likert scale (from 1 = "strongly disagree" to 5 = "strongly agree"). The total score is the average of the 12 item scores (possible range: 1 through 5, where 5 is the best possible outcome).	Baseline, endpoint (i.e, at least 8 weeks from resource package receipt)

Collaborators and Investigators

• Sponsor: Children's Hospital of Philadelphia
• Collaborators: National Institute of Mental Health (NIMH)
• Investigators: Principal Investigator: Gwendolyn M Lawson, PhD, Children's Hospital of Philadelphia/University of Pennsylvania Perelman School of Medicine

Study record dates

Study Major Dates

• Study Start (Actual): September 20, 2022
• Primary Completion (Actual): June 18, 2024
• Study Completion (Actual): June 18, 2024

Study Registration Dates

• First Submitted: August 2, 2022
• First Submitted That Met QC Criteria: August 3, 2022
• First Posted (Actual): August 5, 2022

Study Record Updates

• Last Update Posted (Actual): July 29, 2025
• Last Update Submitted That Met QC Criteria: July 28, 2025
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Keywords: Attention Deficit Hyperactivity Disorder; Inattentive; Hyperactive; Impulsive; Positive Behavior Management; Positive Behavioral Interventions and Supports; Behavioral Classroom Management
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Mental Disorders; Neurodevelopmental Disorders; Attention Deficit and Disruptive Behavior Disorders; Dyskinesias; Hyperkinesis; Attention Deficit Disorder with Hyperactivity
• Other Study ID Numbers: 22-019825; K23MH122577 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No