Skip to main content
Intended for healthcare professionals

Abstract

This article features two studies examining the impact of a Tier 2 intervention—Recognize. Relax. Record. (RRR)—designed to support elementary students with internalizing behaviors by helping them manage anxious feelings and increase academic engagement. We collaborated with teachers to use screening and attendance data to locate students who might benefit from RRR. Results of a multiple-baseline design across participants study with five students provided modest evidence of a functional relation between introduction of RRR Instruction and decreases in variability of students’ engagement during academic instruction. These shifts were mostly small in magnitude and in need of replication and future inquiry before generalizing results.
Treatment integrity data suggested high levels of implementation fidelity. Overall, social validity ratings were positive for most participants; however, some variability in ratings across students—as well as differences in adults’ pre- to post-intervention ratings—suggested the intervention was more acceptable for supporting some students than others. Results of an A–B nonexperimental study provided descriptive data suggesting potential benefits of implementing RRR instruction in a small-group format. We discuss the findings of this initial test of RRR, noting limitations and directions for future inquiry.

Get full access to this article

View all access and purchase options for this article.

Data availability statement

Research materials are available from the first and second authors. Additional supplementary materials can also be accessed at the Open Science Framework page associated with this study (Lane et al., 2022).

References

Achenbach T. M. (2001). Manual for ASEBA school-age forms & profiles. University of Vermont, Research Center for Children, Youth & Families.
Algozzine B., Barrett S., Eber L., George H., Horner R., Lewis T., Putnam B., Swain-Bradway J., McIntosh K., Sugai G. (2014). School-wide PBIS Tiered Fidelity Inventory. OSEP Technical Assistance Center on Positive Behavioral Interventions and Supports. www.pbis.org
American Psychiatric Association. (2022). The diagnostic and statistical manual of mental disorders (Fifth Edition; DSM-5-TR).
Bera L., Souchon M., Ladsous A., Colin V., Lopez-Castroman J. (2022). Emotional and behavioral impact of the COVID-19 epidemic in adolescents. Current Psychiatry Reports, 24(1), 37–46. https://doi.org/10.1007/s11920-022-01313-8
Bernard A. M., Buckman M. M., Lane K. L., Sherod R. L., Pelton K. S. L., Common E. A. (2025). A systematic review of check-in/check-out as a Tier 2 support for students with internalizing behaviors [Manuscript submitted for publication]. University of Kansas.
Bradshaw C. P., Buckley J. A., Ialongo N. S. (2008). School-based service utilization among urban children with early onset educational and mental health problems: The squeaky wheel phenomenon. School Psychology Quarterly, 23(2), 169–189. https://doi.org/10.1037/1045-3830.23.2.169
Briesch A. M., Chafouleas S. M. (2009). Review and analysis of literature on self-management interventions to promote appropriate classroom behaviors (1988–2008). School Psychology Quarterly, 24(2), 106–118. https://doi.org/10.1037/a0016159
Buckman M. M., Lane K. L., Royer D. J., Common E. A., Oakes W. P., Briesch A., Chafouleas S. M., Sherod R. L., Pérez P., Iovino E., Allen G. E., Artola Bonanno A., Lane N. A. (2024). Enhancing Ci3T professional learning: Initial lessons learned from Ci3T implementers. Education and Treatment of Children, 47, 303–323. https://doi.org/10.1007/s43494-024-00127-y
Chafouleas S. M., Riley-Tillman T. C., Christ T. J. (2009a). Direct behavior rating (DBR): An emerging method for assessing social behavior within a tiered intervention system. Assessment for Effective Intervention, 34(4), 195–200. https://doi.org/10.1177/1534508409340391
Chafouleas S. M., Riley-Tillman T. C., Christ T. J., Sugai G. (2009b). Direct Behavior Rating (DBR) Form: 3 Standard Behaviors. https://dbr.education.uconn.edu/
Chafouleas S. M., Sanetti L. M., Kilgus S. P., Maggin D. M. (2012). Evaluating sensitivity to behavioral change using direct behavior rating single-item scales. Exceptional Children, 78(4), 491–505. https://doi.org/10.1177/001440291207800406
Chorpita B. F., Daleiden E. L. (2009). Mapping evidence-based treatments for children and adolescents: Application of the distillation and matching model to 615 treatments from 322 randomized trials. Journal of Consulting and Clinical Psychology, 77(3), 566–579. https://doi.org/10.1037/a0014565
Ci3T Project ENHANCE Research Team. (2021). Recognize. Relax. Record. An intervention package for students struggling with anxious feelings. https://doi.org/10.17161/ci3t.63640.
Committee for Children. (1992). Second Step: A violence prevention curriculum. https://www.cfchildren.org/programs/
Common E. A., Buckman M. M., Lane K. L., Leko M., Royer D. J., Oakes W. P., Allen G. E. (2019). Exploring solutions to address students’ social competencies to facilitate school success: A usability and feasibility study. Education and Treatment of Children, 42(4), 489–514. https://doi.org/10.1353/etc.2019.0023
Common E. A., Buckman M. M., Lane K. L., Oakes W. P., Royer D. J., Chafouleas S., Briesch A., Sherod R. (2021). Project ENHANCE: Assessing professional learning needs for implementing Comprehensive, Integrated, Three-tiered (Ci3T) Models of Prevention. Education and Treatment of Children. https://doi.org/10.1007/s43494-021-00049-z
Cook B., Buysse V., Klingner J., Landrum T., McWilliam R., Tankersley M., Test D. (2014). Council for exceptional children: Standards for evidence-based practices in special education. Teaching Exceptional Children, 46(6), 206. https://doi.org/10.1177/0741932514557271
Cooper J. O., Heron T. E., Heward W. L. (2020). Applied behavior analysis (3rd ed.). Pearson.
Dart E. H., Furlow C. M., Collins T. A., Brewer E., Gresham F. M., Chenier K. H. (2015). Peer mediated Check-In/Check-Out for students at-risk for internalizing disorders. School Psychology Quarterly, 30, 229–243. https://doi.org/10.1037/spq0000092
Deng J., Zhou F., Hou W., Heybati K., Lohit S., Abbas U., Silver Z., Wong C. Y., Chang O., Huang E., Zuo Q. I., Moskalyk M., Bamaraju H. B., Heybati S. (2023). Prevalence of mental health symptoms in children and adolescents during the COVID-19 pandemic: A meta-analysis. Annals of the New York Academy of Sciences, 1520(1), 53–73. https://doi.org/10.1111/nyas.14947
Drummond T. (1994). The Student Risk Screening Scale (SRSS). Josephine County Mental Health Program.
Duong M. T., Bruns E. J., Lee K., Cox S., Coifman J., Mayworm A., Lyon A. R. (2021). Rates of mental health service utilization by children and adolescents in schools and other common service settings: A systematic review and meta-analysis. Administration and Policy in Mental Health and Mental Health Services Research, 48, 420–439. https://doi.org/10.1007/s10488-020-01080-9
Eklund K., Kilgus S. P., Izumi J., DeMarchena S. L., McCollom E. M. (2021). The resilience education program: Examining the efficacy of a Tier 2 internalizing intervention. Psychology in the Schools, 58(11), 2114–2129. https://doi.org/10.1002/pits.22580
Farmer E. M., Burns B. J., Phillips S. D., Angold A., Costello E. J. (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services, 54(1), 60–66. https://doi.org/10.1176/appi.ps.54.1.60
Gandhi A. G., Clemens N., Coyne M., Goodman S., Lane K. L., Lembke E., Simonsen B. (2023). Integrated multi-tiered systems of support (I-MTSS): New directions for supporting students with or at risk for learning disabilities. In Swanson H. L., Harris K. R., Graham S. (Eds.), Handbook of learning disabilities (3rd ed.). Guilford Press.
Gresham F. M., Elliott S. N. (2008). Social skill improvement system: Rating scale manual. Pearson Assessments.
Gresham F. M., Kern L. (2004). Internalizing behavior problems in children and adolescents. In Rutherford R. B., Quinn M. M., Mathur S. R. (Eds.), Handbook of research in emotional and behavioral disorders (pp. 262–281). Guilford Press.
Gresham F. M., Lane K. L., MacMillan D. L., Bocian K. M. (1999). Social and academic profiles of externalizing and internalizing groups: Risk factors for emotional and behavioral disorders. Behavioral Disorders, 24, 231–245. https://doi.org/10.1177/019874299902400303
Henricsson L., Rydell A.-M. (2006). Children with behaviour problems: The influence of social competence and social relations on problem stability, school achievement and peer acceptance across the first six years of school. Infant and Child Development, 15, 347–366. https://doi.org/10.1002/icd.448
I-MTSS Research Network. (2023). What is an integrated multi-tiered system of support? Integrated multi-tiered systems of support research network, University of Connecticut. http://www.mtss.org
Institute of Education Sciences. (2021). Request for applications: Research to accelerate pandemic recovery in special education. U.S. Department of Education.
January S. A. A., Ardoin S. P. (2015). Technical adequacy and acceptability of curriculum-based measurement and the measures of academic progress. Assessment for Effective Intervention, 41(1), 3–15. https://doi.org/10.1177/153450841557909
Kilgus S. P., Eklund K. (2017). Resilience education program Unpublished curriculum and workbook.
Kilgus S. P., Reinke W. M., Jimerson S. R. (2015). Understanding mental health intervention and assessment within a multi-tiered framework: Contemporary science, practice, and policy. School Psychology Quarterly, 30(2), 159–165. https://doi.org/10.1037/spq0000118
Kratochwill T. R., Hitchcock J. H., Horner R. H., Levin J. R., Odom S. L., Rindskopf D. M., Shadish W. R. (2013). Single-case intervention research design standards. Remedial and Special Education, 34(1), 26–38. https://doi.org/10.1177/0741932512452794
Lane K. L. (1999). Young students at-risk for antisocial behavior: The utility of academic and social skills interventions. Journal of Emotional and Behavioral Disorders, 7, 211–223. https://doi.org/10.1177/106342669900700403
Lane K. L. (2009a). Comprehensive, Integrated Three-tiered (Ci3T) model of prevention Treatment Integrity: Teacher Self-Report Form (Ci3T TI: TSR). www.ci3t.org/measures
Lane K. L. (2009b). Comprehensive, Integrated Three-tiered (Ci3T) model of prevention Treatment Integrity: Direct Observation Tool (Ci3T TI: DO). www.ci3t.org/measures
Lane K. L. (Principal Investigator). (2019–2024). Enhancing Ci3T: Building professional capacity for high fidelity implementation to support students’ educational outcomes (Project ENHANCE; Award Number: R324N190002) [Grant]. Institute of Education Sciences. https://ies.ed.gov/funding/grantsearch/details.asp?ID=2235
Lane K. L. (Principal Investigator). (2022–2026). Project ENGAGE: Enhancing Student engagement to facilitate learning and well-being (Project ENGAGE; Award Number: R324X220067) [Grant]. Institute of Education Sciences. https://ies.ed.gov/use-work/awards/project-engage-enhancing-student-engagement-facilitate-learning-and-well-being
Lane K. L., Beebe-Frankenberger M. (2004). School-based interventions: The tools you need to succeed. Pearson.
Lane K. L., Buckman M. M., Oakes W. P., Common E. A. (2022, October 11). Project ENGAGE: Exploring Recognize. Relax. Record. (RRR) to support student success [Preregistration]. http://osf.io/6mskr
Lane K. L., Harris K., Graham S., Driscoll S., Sandmel K., Morphy P., Herbert M., House E., Schatschneider C. (2011). Self-regulated strategy development at Tier 2 for second-grade students with writing and behavioral difficulties: A randomized controlled trial. Journal of Research on Educational Effectiveness, 4(4), 322–353. https://doi.org/10.1080/19345747.2011.558987
Lane K. L., Kalberg J. R., Menzies H. M. (2009). Developing schoolwide programs to prevent and manage challenging behaviors: A step-by-step approach (1st ed.). Guilford Press.
Lane K. L., Menzies H. M. (2009). Student Risk Screening Scale for Internalizing and Externalizing Behavior (SRSS-IE). http://www.ci3t.org/screening.
Lane K. L., Menzies H. M., Bruhn A. L., Crnobori M. (2011). Managing challenging behaviors in schools: Research-based strategies that work. Guilford Press.
Lane K. L., Menzies H. M., Oakes W. P., Kalberg J. R. (2020). Developing a schoolwide framework to prevent and manage learning and behavior problems (2nd ed.). Guilford Press.
Lane K. L., Menzies H. M., Smith-Menzies L., Lane K. S. (2023). Classroom management to support students with disabilities: Empowering general and special educators. In Sabornie E., Espelage D. (Eds.), Handbook of classroom management: Research, practice, and issues (pp. 499–516). Routledge.
Lane K. L., Oakes W. P., Cantwell E. D., Common E. A., Royer D. J., Leko M., Schatschneider C., Menzies H. M., Buckman M. M., Allen G. E. (2019). Predictive validity of Student Risk Screening Scale for Internalizing and Externalizing (SRSS-IE) scores in elementary schools. Journal of Emotional and Behavioral Disorders, 27(4), 221–234. https://doi.org/10.1177/1063426618795443
Lane K. L., Oakes W. P., Menzies H. M. (2021). Considerations for systematic screening PK-12: Universal screening for internalizing and externalizing behaviors in the COVID-19 era. Preventing School Failure: Alternative Education for Children and Youth, 65, 275–281. https://doi.org/10.1080/1045988X.2021.1908216
Lane K. L., Oakes W. P., Swogger E. D., Schatschneider C., Menzies H. M., Sanchez J. (2015). Student Risk Screening Scale For Internalizing And Externalizing Behaviors: Preliminary cut scores to support data-informed decision making. Behavioral Disorders, 40, 159–170. https://doi.org/10.17988/0198-7429-40.3.159
Lane K. L., Wolery M., Reichow B., Rogers L. (2006). Describing baseline conditions: Suggestions for study reports. Journal of Behavioral Education, 16, 224–234. https://doi.org/10.1007/s10864-006-9036-4
Lebrun-Harris L. A., Ghandour R. M., Kogan M. D., Warren M. D. (2022). Five-year trends in US children’s health and well-being, 2016-2020. JAMA Pediatrics, 176(7), e220056. https://doi.org/10.1001/jamapediatrics.2022.0056
Ledford J. R., Gast D. L. (Eds.). (2024). Single case research methodology: Applications in special education and behavioral sciences (4th ed.). Routledge.
Lembke E. (2012). Tier 2 interventions for internalizing behavior problems. In Stormont M., Reinke W.M., Herman K.C., Lembke E. (Eds.), Academic and behavior supports for at-risk students: Tier 2 interventions (pp. 69–100). Guilford Press.
Levin H. M., McEwan P. J., Belfield C., Bowden A. B., Shand R. (2017). Economic evaluation in education: Cost-effectiveness and benefit-cost analysis (3rd ed.). Sage.
McIntosh K., Ty S. V., Miller L. D. (2014). Effects of school-wide positive behavioral interventions and supports on internalizing problems: Current evidence and future directions. Journal of Positive Behavior Interventions, 16(4), 209–218. https://doi.org/10.1177/1098300713491980
Merikangas K. R., He J. P., Burstein M., Swanson S. A., Avenevoli S., Cui L., Benjet C., Georgiages K., Swendsen J. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989. https://doi.org/10.1016/j.jaac.2010.05.017
Merrell K. W., Gueldner B. A. (2010). Preventative interventions for students with internalizing disorders: Effective strategies for promoting mental health in schools. In Shinn M. R., Walker H. M. (Eds.), Interventions for achievement and behavior problems in a three-tier model including RTI. National Association of School Psychologists.
Minkos M. L., Gelbar N. W. (2020). Considerations for educators in supporting student learning in the midst of COVID-19. Psychology in the Schools, 58(2), 416–426. https://doi.org/10.1002/pits.22454
Mitchell B. S., Lewis T. J., Stormont M. (2021). A daily check-in/check-out intervention for students with internalizing concerns. Journal of Behavioral Education, 30(2), 178–201. https://doi.org/10.1007/s10864-020-09365-7
Mooney P., Ryan J. B., Uhing B. M., Reid R., Epstein M. H. (2005). A review of self-management interventions targeting academic outcomes for students with emotional and behavioral disorders. Journal of Behavioral Education, 14, 203–221. https://doi.org/10.1007/s10864-005-6298-1
Mychailyszyn M. P., Mendez J. L., Kendall P. C. (2010). School functioning in youth with and without anxiety disorders: Comparisons by diagnosis and comorbidity. School Psychology Review, 39, 106–121. https://doi.org/10.1080/02796015.2010.12087793
National Center for Education Statistics. (2023). Recovery from the coronavirus pandemic in K–12 education: Condition of Education. U.S. Department of Education, Institute of Education Sciences. https://nces.ed.gov/programs/coe/indicator/toa/k-12-covid-recovery
Northwest Evaluation Association. (2009). Technical manual for Measures of Academic Progress and Measures of Academic Progress for primary grades.
Pustejovsky J. E. (2018). Using response ratios for meta-analyzing single-case designs with behavioral outcomes. Journal of School Psychology, 68, 99–112. https://doi.org/10.1016/j.jsp.2018.02.003
Pustejovsky J. E., Chen M., Grekov P., Swan D. M. (2024). SingleCaseES: A calculator for single-case effect size indices (Version 0.7.3) [R package]. https://jepusto.github.io/SingleCaseES/
Pustejovsky J. E., Chen M., Hamilton B., Grekov P. (2023). scdhlm: A web-based calculator for between-case standardized mean differences (Version 0.7.2) [Web application]. https://jepusto.shinyapps.io/scdhlm
Richtel M. (2023, March 21). The Surgeon General’s new mission: Adolescent mental health. The New York Times. https://www.nytimes.com/2023/03/21/health/surgeon-general-adolescents-mental-health.html
Shadish W. R., Zelinsky N. A., Vevea J. L., Kratochwill T. R. (2016). A survey of publication practices of single-case design researchers when treatments have small or large effects. Journal of Applied Behavior Analysis, 49(3), 656–673. https://doi.org/10.1002/jaba.308
Swan D. M., Pustejovsky J. E. (2018). A gradual effects model for single-case designs. Multivariate Behavioral Research, 53(4), 574–593. https://doi.org/10.1080/00273171.2018.1466681
Tse Z., Emad S., Hasan M., Papathanasiou I., Rehman I., Lee K. (2023). School-based cognitive-behavioural therapy for children and adolescents with social anxiety disorder and social anxiety symptoms: A systematic review. PLOS ONE, 18. https://doi.org/10.1371/journal.pone.0283329
Umbreit J., Ferro J. B., Lane K. L., Liaupsin C. J. (2024). Functional assessment-based intervention: Effective individualized support for students. Guilford Publications.
University of Connecticut. (n.d.) . Direct Behavior Rating training module. https://dbrtraining.education.uconn.edu/
Valentine J. C., Tanner-Smith E. E., Pustejovsky J. E. (2016). Between-case standardized mean difference effect sizes for single-case designs: A primer and tutorial using the SCDHLM web application. The Campbell Collaboration. https://doi.org/10.4073/cmpn.2016.3
Walker H. M., Forness S. R., Lane K. L. (2014). Design and management of scientific research in applied school settings. In Advances in learning and behavioral disabilities special education past, present, and future: Perspectives from the field (Vol. 27, pp. 141–169). Emerald Group Publishing Limited. https://doi.org/10.1108/S0735-004X20140000027009
Willner C. J., Gatzke-Kopp L. M., Bray B. C. (2016). The dynamics of internalizing and externalizing comorbidity across the early school years. Development and Psychopathology, 28(4, pt. 1), 1033–1052. https://doi.org/10.1017/s0954579416000687
Witt J. C., Elliott S. N. (1985). Acceptability of classroom intervention strategies. In Kratochwill T. R. (Ed.), Advances in school psychology (Vol. 4). Erlbaum.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.