Organizational Skills Training - Tier 2 (OST-T2)

Not Applicable

Completed

Conditions: Behavior Therapy
Behavioral Research
Executive Function
Schools

Interventions: Behavioral: Organizational Skills Training - School Based (OST-S)

Registration Number: NCT03443323

Lead Sponsor: Children's Hospital of Philadelphia

Brief Summary: The purpose of this study was to evaluate the Organizational Skills Training Program - Tier 2 version (OST-T2) in a cluster randomized trial. Participating schools will be randomly assigned to one of two groups: 1) an OST-T2 intervention group and 2) a treatment as usual control group. Participating students (3rd through 5th grade) were from 22 schools in Pennsylvania and New Jersey and included both urban and suburban schools serving a diverse population. OST-T2 is a small-group, skills training intervention for children, which includes parent and teacher consultation to support student use of new skills. The program is delivered by school staff who receive training and consultation from intervention experts.

Detailed Description: Context: Although multiple factors influence school functioning, executive function (EF) deficits have been found to be a key predictor of academic achievement. EF is a higher order cognitive ability associated with persistent goal-directed behavior. Organization, time management, and planning (OTMP) skills are aspects of EF that are particularly associated with children's academic performance. Organizational demands increase over the course of early schooling and are relatively high by 3rd through 5th grade. Poor OTMP skills during this period adversely impact academic functioning. In the late elementary school grades, as students are expected to become more organized, some students have difficulty learning these skills in spite of classroom supports provided by teachers, placing them at increased risk for academic failure.

Objectives: The purpose of this study was to conduct an evaluation of the Organizational Skills Training Program - Tier 2 version (OST-T2), a fully developed intervention for students in general education. The proposed study builds upon research demonstrating the efficacy of a clinic-based version of the OST intervention (OST-C) in remediating OTMP skills deficits and improving academic functioning for 3rd, 4th and 5th graders with attention-deficit hyperactivity disorder (ADHD), and a recent pilot research demonstrating the feasibility and potential effectiveness of a school-based version of OST provided by end users ("school partners") for 3rd through 5th graders. It also builds upon research training school staff to implement evidence-based interventions with high fidelity.

Study Design: This is a cluster-randomized trial with a treatment as usual (TAU) control group.

Setting/Participants: Schools (22) were located in Pennsylvania and New Jersey and include urban and suburban schools serving a diverse population. Students (3rd to 5th grade) who are struggling the most with OTMP deficits and whose academic performance is negatively impacted by their OTMP deficits will be referred to the study team by their general education teachers.

Study Interventions and Measures: OST-T2 is a small group skills training intervention, with parents and teachers supporting children's use of new skills. The program manual includes strategies for training and coaching school staff, referred to as school partners, to effectively implement OST-T2 and guidelines to modify the program for implementation in diverse schools with diverse students. Each student session includes: (a) homework review to assess completion of between-session skills implementation; (b) skill-building activities, which include the use of modeling, shaping, guided practice, and reinforcement for organized behavior; and (c) activities to promote generalization of skills. Sessions address four organizational challenges: (a) tracking assignments, (b) managing materials, (c) managing time, and (d) planning for long term assignments.

Investigators measured the following: intervention fidelity, stakeholder engagement, student OTMP skills, student academic self-efficacy, student academic outcomes, student characteristics, feasibility, usability, and acceptability of OST-T2. In addition, investigators tracked the interventions that are offered as treatment-as-usual in TAU schools. A cost analysis related to the implementation of OST-T2 will also be completed.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 186

Inclusion Criteria

Any student enrolled in grades 3 through 5 in one of the participating schools who meets the following criteria.

First, students will be recommended by their general education teacher if the following are true: (a) students who are struggling the most with OTMP skills, (b) whose OTMP skill deficits are the students' primary concern (c) whose academic performance is negatively impacted by their OTMP deficits, and (d) who have at least one parent who speaks English.
Second, students must have or be at risk for developing OTMP deficits.

Exclusion Criteria

Students will be excluded if they are in a pull-out special education classroom for more than 50% of the day as the organizational demands for these students may differ from those students placed mostly in general education.
Students with a one-to-one aide will be excluded because the presence of an aide substantially alters how an organizational intervention is implemented.
Students from families in which both caregivers do not speak English will be excluded because the program has not yet been developed for non-English speakers.
Only one student per family will be included in the study.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
OST-S Intervention group	Organizational Skills Training - School Based (OST-S)	-

Primary Outcome Measures

Name	Time	Method
Students' Organizational Functioning - Teacher Report	Baseline, 14-weeks (post-treatment), 5-months and 12-months	The Children's Organizational Skills Scales - Teacher Version (COSS-T) was used to assess changes in OTMP functioning at home and school over several time points. COSS total scores have good discriminant validity and are sensitive to treatment effects. Each COSS version uses a 4-point rating scale (1=Hardly ever or never to 4=Just about all of the time). Higher scores indicate a worse outcome. Although the COSS yields three subscale scores, only the total score of 28 items was used to reduce the number of measures in the analyses. The mean item score was calculated and used in analyses; possible range is from 1 to 4.
Students' Organizational Functioning - Parent Report	Baseline, 14-weeks (post-treatment), 5-months and 12-months	The Children's Organizational Skills Scales - Parent Version (COSS-P) was used to assess changes in OTMP functioning at home and school over several time points. COSS total scores have good discriminant validity and are sensitive to treatment effects. Each COSS version uses a 4-point rating scale (1=Hardly ever or never to 4=Just about all of the time). Higher scores indicate a worse outcome. Although the COSS yields three subscale scores, only the 26-item total score was used to reduce the number of measures in the analyses. The mean item score was calculated and used in analyses; possible range is from 1 to 4.

Secondary Outcome Measures

Name	Time	Method
Students' Homework Performance - Teacher Report	Baseline, 14-weeks (post-treatment), 5-months and 12-months	The Homework Performance Questionnaire (HPQ-T)-Teacher version was used to assess changes in students' homework behavior during the past 4 weeks. Each item is rated on a five-point scale corresponding to amount of time student demonstrated the behavior in the previous 4-week period (0 = 0% to 39% of the time; 1 = 40% to 69% of the time; 2 = 70% to 79% of the time; 3 = 80% to 89% of the time; 4 = 90% to 100% of the time).Higher scores indicate better outcome. The 9-item Student Self-Regulation factor was used in the analyses. This factor has been demonstrated to have strong psychometric properties. Mean item score was used in analyses; possible range is from 0 to 4.
Students' Homework Performance - Parent Report	Baseline, 14-weeks (post-treatment), 5-months and 12-months	The Homework Problem Checklist (HPC) is a 20-item parent-report measure that was used to assess changes in student homework performance. Parents indicate the frequency with which student engage in behavior during homework time at home on a four-point scale (0 = never to 3 = very often). The psychometric properties of this instrument have been shown to be acceptable, and the HPC was sensitive to treatment effects in the previous OST-C study. The total HPC score was used in the analyses. Higher scores indicate worse outcomes. Mean item score was calculated and used in analyses; possible range is from 0 to 3.
Student Academic Proficiency	Baseline, 14-weeks (post-treatment), 5-months and 12-months	The Academic Proficiency Scale (APS) is a teacher-report measure that assesses (changes in) proficiency in six academic subjects relative to standard expectations (1=Well below standard expected at this time of year; 3=At standard; 5=Well above standard). Higher scores indicate a better outcome. Ratings were averaged across six academic subjects; mean item score is the unit of analysis. Possible range is from 1 to 5. Reliability is acceptable (alpha = .84), and this measure is sensitive to OST treatment effects.
Student Academic Competence	Baseline, 14-weeks (post-treatment), 5-months and 12-months	The Academic Competence Evaluation Scales (ACES) is a teacher-report scale that assesses changes in the academic competence of students in kindergarten through grade 12. The Reading/Language Arts and Math subscales of this measure were used. Items are rated from 1 = far below to 5 = far above grade level. Higher scores indicate better outcome. Alpha coefficients and test-retest correlations for these subscales have been shown to be above .90. The average item score for Reading/Language Arts (11 items) and Math (8 items) subscales were calculated. Then the average of these subscale scores was used in the analyses. Possible range is from 1 to 5.
Student Academic Grades	Baseline, 5-months	Student report card grades for the first marking period of the year students participate in OST-T2/TAU and for the last marking period of the academic year of participation were used to examine impact on academic performance. Grades were harmonized across participating school districts to a uniform grading scale (ranging from low of 1 to high of 4). A composite academic grade score was computed for each student based on their grades in math and reading/language arts (possible range = 1 to 4). Higher scores indicate better outcomes.
Student Self-efficacy	Baseline, 14-weeks (post-treatment), 5-months and 12-months	Patterns of Adaptive Learning Scales (PALS) was used to evaluate changes in students' perceptions of their ability to overcome challenges to perform their class work (e.g., "I can do even the hardest work in this class if I try."). Items are rated on a 5-item scale from 1 = not at all true to 5 = very true. Higher scores indicate better outcomes. Mean item scores were used in analyses; possible range is from 1 to 5.

Trial Locations

Locations (3): Children's Hospital of Philadelphia
🇺🇸
Philadelphia, Pennsylvania, United States
New York University
🇺🇸
New York, New York, United States
University of Pennsylvania
🇺🇸
Philadelphia, Pennsylvania, United States